Thoughts from the void: Cannabis and Opium

'It is possible to detach yourself from most pain - injury to teeth, eyes, and genitals present special difficulties - so that the pain is experienced as neutral excitation. From junk sickness there seems to be no escape. Junk sickness is the reverse side of junk kick. The kick of junk is that you have to have it. Junkies run on junk time and junk metabolism. They are subject to junk climate. They are warmed and chilled by junk. the kick of junk is living under junk conditions. You cannot escape from junk sickness any more than you can escape from junk kick after a shot.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Total prohibition of the cultivation of the hemp plant for narcotics, and the manufacture, sale or use of the drugs from it is neither necessary nor expedient in consideration of their ascertained effects, of the prevalence of the habit of using them, of the social and religious feeling on the subject, and of the possibility of its driving the consumers to have recourse to other stimulants or narcotics which may be more deleterious (Chapter XIV, paragraph 553 to 585)'

- Conclusions of the Commission, Report of the Indian Hemp Drugs Commission, 1894-1895

'An estimated 192 million people used cannabis in 2018, making it the most used drug globally. In comparison, 58 million people used opioids in 2018. But that lower number of users belies the harm associated with opioids. This group of substances accounted for 66 per cent of the estimated 167,000 deaths related to drug use disorders in 2017 and 50 per cent of the 42 millions years (or 21 million years) lost due to disability or early death, attributed to drug use.'

- United Nations Office on Drugs and Crime, World Drug Report 2020

'After his death, a notebook of poetry written by [Jim] Morrison was recovered, titled Paris Journal; amongst other personal details, it contains the allegorical foretelling of a man who will be left grieving and having to abandon his belongings, due to a police investigation into a death connected to the Chinese opium trade. "Weeping, he left his pad on orders from police and furnishings hauled away, all records and mementos, and reporters calculating tears & curses for the press: 'I hope the Chinese junkies get you and they will for the [opium] poppy rules the world".'

- Wikipedia

The opium crisis

Among the adversaries of cannabis, I rate opium as number one. Alcohol kills 3 million people world wide every year but it does not have the clout that opium has, with its backing from wealthy nations and individuals, includng the medical and pharmaceutical industry. Opium and its derivatives killed about 67,000 people in 2019, in the US alone. The United Nations Office on Drugs and Crime (UNODC), World Drug Report 2020 says that 'Opioids, which include opiates (heroin and opium) and pharmaceutical and other synthetic opioids, are a major concern in many countries because of the severe health consequences associated with their use. For example, in 2017, the use of opioids accounted for nearly 80 per cent of the 42 million years of “healthy” life lost as a result of disability and premature death (disability-adjusted life years, or DALYs) and 66 per cent of the estimated 167,000 deaths attributed to drug use disorders.' UNODC reports that 'The number of overdose deaths in the United States reached its peak in 2017 at 70,237 deaths (21.7 deaths per 100,000 population), of which 47,600 (68 per cent: 14.9 deaths per 100,000 population) were attributed to opioids. In 2018, for the first time since 1999, the number of overdose deaths declined over the previous year by 4 per cent to 67,367 deaths (20.7 deaths per 100,000 population). Opioids were responsible for most of those deaths, accounting for 46,802 in total in 2018 (14.6 deaths per 100,000 population), of which 67 per cent were attributed to fentanyls.' This decline did not last for long, because by 2020 the numbers were up again. Wall Street Journal reports that 'The estimated 93,331 deaths from drug overdoses last year, a record high, represent the sharpest annual increase in at least three decades, and compare with an estimated toll of 72,151 deaths in 2019, according to provisional overdose-drug data released Wednesday by the Centers for Disease Control and Prevention....An estimated 57,550 people died of overdoses from synthetic opioids, primarily fentanyl, an increase of more than 54% over 2019, according to Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. “Definitely fentanyl is the driving factor,” he said. Overdose deaths from opioids overall rose nearly 37%, according to the CDC data.' UNODC furthers says that 'The opioid crisis continues in North America, with a new record level in the number of opioid overdose deaths attributed to the use of fentanyl and its analogues. These substances are added to heroin and other drugs as adulterants and are also sold as counterfeit prescription opioids, such as oxycodone or hydrocodone, and even as counterfeit benzodiazepines, to a large unsuspecting population of users of opioids and other drugs. In 2018, in the United States, 10.3 million people or 3.7 per cent of the population aged 12 and older had misused opioids in the past year. Of those people, 9.9 million (3.6 per cent of the population) reported the non-medical use of prescription opioids while nearly 800,000 reported past-year use of heroin.' This is just the officially known cases in the US. Globally, opium and its synthetic successor, fentanyl, are responsible for the majority of overdose deaths. Most countries do not have proper data on deaths. Quite often, deaths that happen due to prescription medication opioid overdoses are attributed to other causes such as respiratory failure, as we witnessed during the recent Covid fake pandemic. Many deaths from opium overdoses due to abuse of prescription opioids, heroin, and fentanyls go unreported, as the user and/or his family kept the addiction secret. EMCDDA reports that 'An update from the EMCDDA expert network, published in July 2019, also highlighted that opioids, often heroin, are involved in between 8 and 9 out of every 10 drug-induced deaths reported in Europe, although this is not true for all countries. Opioids used in substitution treatment can also be found in post-mortem analyses in some countries. Deaths related to medications, such as oxycodone and tramadol, are also reported. Deaths associated with fentanyl and its analogues are probably underestimated, and outbreaks of deaths related to these substances have been reported.' NCBI reports that 'By 2013, over 1,000 Americans were treated daily in emergency departments for prescription opioid misuse and in 2014, 4.3 million people used prescription opioids for non-medical reasons. This trend was also seen in the number of deaths attributed to oxycodone, which increased from 14 cases in 1998 to ~14,000 cases in 2006 and 18,000 in 2015. Although not of the same magnitude and somewhat delayed, this increase in opioid abuse and mortality is also occurring in other countries. In Australia, oxycodone-related deaths increased sevenfold between 2001 and 2011. In Finland, opioid mortalities increased from 9.5% of all drug overdose deaths in 2000 to 32.4% in 2008, and data from Brazil, China, and the Middle East show similar increases in opioid diversion. In the United Kingdom, although tramadol and methadone are misused over oxycodone, the pattern of opioid misuse shows a similar increase to the USA albeit on a smaller scale. While Americans consume 80% of the global opioid supply and 99% of the global hydrocodone supply and the number of overdose mortalities is considerably higher in the USA, the opioid epidemic is growing worldwide.' EMCDDA reports that 'Opioids, mainly heroin or its metabolites, often in combination with other substances, are present in the majority of fatal overdoses reported in Europe. In most drug-related deaths, more than one substance is detected, indicating polydrug use. Overall, opioids are involved in 77.8% of cases, with large differences across countries.' EMCDDA further reports that 'Scotland’s drug-death rate among adults (15–64 years) is higher than those reported for all the EU countries (although there are issues of coding, coverage and under-reporting in some countries). To illustrate the scale of the problem, Scotland with a population of 5.5 million reports a similar number of overdose deaths as Germany does that has a population of 83 million. Most cases in Scotland are associated with opioids (9 in 10) and benzodiazepines (7 in 10) but almost all 85% involve more than one drug. Recent increases are primarily seen in the 35–44 and 45–54 age groups.' EMCDDA says 'The type of substance used, the route of administration and the health of the user all have an impact on the risk of overdose. Most overdose deaths are linked to the use of opioids, primarily the injection of heroin or synthetic opioids, while polydrug use is also very common, including the combination of heroin or other opioids with other central nervous system depressants, such as alcohol or benzodiazepines, which bears particularly high risks. Using/injecting alone is also a risk factor for overdose death.' UNODC reports that 'The situation is particularly complex for the opioids group, as both legally and illegally produced substances satisfy the non-medical demand for opioids. While illegally produced opiates, such as heroin, used to dominate the non-medical demand for opioids, the illicit opioid markets in many countries have become far more diversified over the past two decades, with a number of pharmaceutical opioids that have started to cover a substantial part of the market for opioids for non-medical purposes.'

Opium - the drug of the elites

Opium affects all classes of society, though it is predominantly the wealthy classes, and the rich upper middle classes, that are the major consumers and victims. Yes, there are persons from the poorer classes who use opium, but they are mostly concentrated around the cultivation areas where access to raw opium is easier for the poor. Once the raw opium starts moving and getting processed, the poor hardly get a glimpse of it. This is because opioids are priced in such a way that only those with the money can afford to abuse it. That is why the global opium industry is so powerful. The leading revenue earners from opium and its derivatives, are the legal and illegal pharmaceutical companies, and those involved in its illegal trafficking. The global opium market runs in hundreds of billions of dollars, at the least. Opium captures its users with addiction. A user hooked to opium will almost certainly become a lifelong user. Most often, what starts as pleasure ends up as a way to avoid junk sickness. A user with an opium habit who does not get the next fix in time can die, as blood pressure drops and respiratory systems fail. The current major cure for opium sickness is to give the user a lesser potent version of opium for a few days, so as to stabilize the user, and then setting the user free. Thus, in this case, opium is both the disease and the cure. The opium distribution from crop to final product is a well-oiled process that involves cultivation in poor countries, processing in more advanced countries and then distribution to the world's rich and powerful through the legal and illegal networks. The legal network consists of pharmaceutical companies, insurance companies, pharmacies and physicians. The pharmaceutical companies manufacture the opioids, primarily as pain killers, and stock it with the pharmacists. They pay huge perks to the medical industry, so that physicians can prescribe opium for patients complaining of pain. Once the user goes through a daily dose of opioids regimen for about three months, then stopping the opioid will cause so much sickness that the initial pain that the patient complained about seems insignificant in comparison. Quite often, the patient starts to self-medicate, ramping up the daily dose rates till they reach a point where this is no longer sustainable, as either opium tolerance or the limits of finances, or both, is reached. The medical insurance industry helps in a big way, by providing insurance money that flows back to the medical industry and pharmaceutical companies. When the limits are reached, the user quite often turns to the illegal market for more potent opioids. Depending on the buying power of the individual, the type of opioid consumed will vary. The well-heeled will go for heroin or morphine, and even be fooled into buying fentanyl derivatives these days. Others will search for morphine, oxycodone, methadone, hydrocodone, etc., in the market. The poorer will look for codeine-based cough syrups and tramadol. The global opium industry ensures that it has enough product to cater to most of these categories. The discovery of fentanyl analogues means that there is no need to even depend on the opium plant anymore. Fentanyls can be manufactured anywhere, and what is better, they command even greater prices than opioids, it appears. UNODC reports that 'Data also show discrepancies in the kind of pharmaceutical opioids available on the medical market. While data for North America show that hydrocodone is the most widely available pharmaceutical opioid (in terms of daily doses per inhabitant), fentanyl is the most widely available opioid in Western and Central Europe and in Australia and New Zealand. The availability for medical consumption of oxycodone is also relatively high in Australia and New Zealand and in North America. By contrast, the availability of codeine for medical consumption appears to be quite limited, although this may be a statistical artefact as most codeine is sold in the form of preparations, the sale of which – falling under Schedule III of the 1961 Single Convention – is internationally less strictly controlled and thus less well documented than the sale of other pharmaceutical opioids.'

The customers for opium and its derivatives run from the middle classes to the super rich. For the majority of the world, its poorest people, there is no recourse to opium, opioids or fentanyls. So, even though they bear the most pain in the world for the actions of the rich, they just have to do without the opium. The poor did have the cannabis, which is the world's foremost medicine, including for pain, but it was taken away. Why? I can think of no better reason than that this is an attempt to widen the net of opium dependence to as many people as possible, and the ones with the money are the ones that matter. The poor cannot afford the opium, so they might as well live with the pain, too bad. The world's rich nations have the cocaine for their craving, and the opium for their addiction. The rich will even do the ganja, just to ensure that they have all the bases covered, and just because they can do it. They will however treat it with the disdain and contempt in public that they would a person of the lower classes that they have sexual relations with in private. The poor can try their hand at methamphetamine, if they are lucky, which I do not think is the case. Then there is, of course, alcohol. If the poor cannot afford the scotch, there is always some cheap whisky that can be procured from government regulated retail outlets.

How opium conquered the world

Cannabis use spread thousands of years ago, along with the Asiatic migrations, to many places in the world. The earliest evidence of cannabis usage culturally is said to be found in Taiwan, dating back about 10,000 years ago. Opium is said to have been discovered in Greece. I believe that it traveled to the east along with European and Middle Eastern travelers and invaders. The opium angle to the prohibition of ganja and/or charas, started in Turkey, the first country to prohibit cannabis in the 12th century, then spread to Egypt and Greece. Its effect on India should not be overlooked. One witness to the Indian Hemp Drugs Commission of 1894-95, Ganesh Krishna Garde, Brahmin, Medical Practitioner, Poona City, states - "If we throw a glance at the history of the introduction of opium into India and China, the same conclusion will be forced upon our mind. We know from the history of cultured plants that the poppy plant is not a native of India and that its intoxicant juice was not known here or in China before the 10th century A. C. It further tells us that the Arabians first brought it from Greece, its native place, and cultivated it in Turkey in Asia, and that from thence the followers of Islam introduced it into the eastern countries. It spread along with their religion and soon became acclimatised in India. The Muhammadans cherished it exceedingly, because in it they found a good substitute for alcohol, the use of which was forbidden to them by their religion. It [opium] found favour with the Chinese for a similar reason, for their new religion Budhism more than even Muhammadanism condemned the use of alcohol. It was under these circumstances that the Chinese came to be possessed of that unsurpassed love for opium for which they are well known." Opium gained significant foothold in Afghanistan and China. The Chinese developed a special liking for opium and cultivated it for their own purposes, and the purposes of the British. Together, they cleared the route for opium between China and Britain, making Burma (now Myanmar) a stepping stone, and Afghanistan, I believe, a midpoint refuel station. With this, the supply lines of opium to Europe were secured, and have, since the last 400 years, provided a steady and secure supply of opium to Europe and Oceania. For North America, the opium cultivated in South America, especially Colombia and now Mexico, provides the nearest fueling station. I suspect that opium may have been introduced in South America by the European settlers, travelers and invaders, just like it happened in China, India and Afghanistan.

To make the supply lines steady for the drugs of craving and addiction, and to ensure that the poor work wholeheartedly, without distractions, it was decided that the globally favored cannabis must be taken out of the picture. Opium cultivation was regulated, in the case of Asia and South America, and coca cultivation, in the case of South America. Through this, not only would the locals focus fully on cultivating opium, they would also consume opium, becoming quickly addicted to the drug. This would ensure a personal stake for the opium cultivator, and increased revenues for the state from the sale of opium, as compared to the nearly negligible revenues that came from cannabis.

India presented a major hurdle to these plans. Cannabis was the drug of the people, used by a majority of the Indian population, in addition to country spirits. Cannabis users were essentially the poorest classes of society. Among the rich, there was a growing number of opium users. To create a market for opium, to increase opium cultivation in India, and also to rake in significant revenue from opium, cannabis was gradually regulated, and then finally prohibited. Various myths were created, such as: cannabis is more dangerous than opium; cannabis causes insanity; cannabis is used by despicable sections of society. Most of the ruling and upper classes bought these myths and offered no resistance to the eventual prohibition of cannabis in India. Thus, the main cannabis producing and using country in the world was made relatively cannabis free, so that opium could move in. And move in, it did. Today, India is the world's largest producer of legal opium. This opium is supplied to pharmaceutical companies in India and abroad to make the various opium derivatives - morphine, oxycodone, methadone, hydrocodone, codeine, heroin, tramadol, etc. Much of the opium is processed outside, so that the more potent versions of opium are sold in the rich European and North American markets. Less potent versions of opium, ones that need more diluted concentrations, are used to prepare codeine and tramadol that are sold to the poorer Indian and African populations. The Indian pharmaceutical industry is one of the richest industries in the country, contributing huge influence and money power to the ruling establishment to ensure that things remain this way. I am sure that the global pharma and medical industry are also doing their bit to ensure that India stays the number one outsourcing destination for all the legal opium in the world. India contributes more than 95% to the world's total legal opium production, so you could say that it is the heart of the global legal opium trade. That's some distance to have traveled from being the world's foremost cannabis country, isn't it? INCB reports that 'In 2018, India was the main producer of raw opium (in addition to being the only country legally exporting raw opium), producing 225.4 tons (24.8 tons in morphine equivalent) and accounting for 97.1 per cent of global production. It was followed by China, which produced 6.6 tons (0.7 ton in morphine equivalent). In China, opium had been the main raw material used in the manufacture of alkaloids until 2000; after that, it was replaced by poppy straw. Japan also produced smaller amounts of opium in 2018, to be used exclusively for scientific purposes. India accounted for 96 per cent of opium exports in 2018. The remaining 4 per cent was accounted for by re-exports of opium by countries that had initially imported the opium from India' It is not just other countries, the Indian population also faces the consequences of its association with opium. UNODC reports that ''A major drug use survey carried out recently in India found that in 2018, 2.1 per cent of the population aged 10–75, a total of 23 million people, had used opioids in the past year. Among opioids, heroin is the most prevalent substance, with a past-year prevalence of 1.1 per cent among the population aged 10–75; this is followed by the non-medical use of pharmaceutical opioids, with a past-year prevalence of almost 1 per cent, and by opium at almost 0.5 per cent. In general, the past-year use of opioids is much higher among men (4 per cent of the male population) than women (0.2 per cent of the female population). Moreover, 1.8 per cent of adolescents aged 10–17 are estimated to be past-year opioid users. Of the 23 million past-year opioid users, roughly one third, or 7.7 million people, suffer from opioid use disorders. Compared with earlier estimates from a survey carried out in 2004, overall opioid use in India is estimated to have increased fivefold.' These numbers are surely an underestimate, as many users, especially among the elites, continue to keep their opium usage under wraps. UNODC further reports that 'The 2019 drug use survey in India estimated that nearly 1 per cent of the population aged 10–75 had misused pharmaceutical opioids in the past year and that an estimated 0.2 per cent of the population (2.5 million people) were suffering from drug use disorders related to pharmaceutical opioids. Although the breakdown by type of pharmaceutical opioids misused in India is not available, buprenorphine, morphine, pentazocine and tramadol are the most common opioids misused in the country.' Recently, Indian newspapers reported the largest seizure of heroin at the Mundra port in Gujarat. Deccan Herald reports that 'The drug haul is considered to be one of the biggest in the world with the value of the seized heroin estimated to be Rs 21,000 crore in the international markets. One kg of the drug sells at Rs 5 to 7 crore.' Gujarat is the home state of the current prime minister of India, Narendra Modi , and the Mundra port is managed by his close ally, Gautam Adani. It is interesting to note that a large part of the opium trafficking in India uses Gujarat, Delhi and Mumbai as transit points. Mumbai is home to Mukesh Ambani, another dear friend of the prime minister. Both Adani and Ambani owe their legal wealth to petrochemicals. What their involvement, and that of the prime minister, is in opium trafficking is anybody's guess. The ruling party in India gets vast financing from the petrochemical and pharmaceutical industry through undisclosed electoral bonds, and owes much of its success in recent elections to its financial clout as compared to the other political parties in India. The subversion of legal opium to the illegal trade, and vice versa, and the ease with which the petrochemical industry can facilitate movement and processing, all indicate a nice happy nexus between pharmaceuticals, petrochemicals and government when it comes to opium. These entities are more than happy to play the outsourcing destination for countries like UK. Make in India, they say. This nexus was quite evident when India became an outsourcing destination for the manufacture of the Covid vaccine developed by the UK. Similar to what happened with opium, the UK used India to manufacture its vaccine cheaply, and sold it to the world. India's ruling establishment, petrochemical and pharmaceutical sectors increased their wealth vastly, as a result of the arrangement. The current Indian government hypnotizes the masses with its brand of upper class religion, calling it Hindutva, while it peddles its upper class opium to the people and the world. The people remain oblivious to all this, revering the opium peddlers as god's chosen ones, and cannabis, the herb of Siva, as a despicable drug.

In 19th century India, when the ruling and upper classes started taking steps to regulate, and ultimately prohibit cannabis, various knowledgeable persons, including medical experts, had warned that prohibition of cannabis would lead to recourse to even more dangerous drugs like opium and alcohol. William O'Shaugnessy, the noted 19th century British physician said "As to the evil sequelæ [with regard to hemp drugs] so unanimously dwelt on by all writers, these did not appear to us so numerous, so immediate, or so formidable as many which may be clearly traced to over-indulgence in other powerful stimulants or narcotics, viz., alcohol, opium, or tobacco." In its summary of the evidence provided in response to the question of prohibiting cannabis in India, the Indian Hemp Drugs Commission of 1894-95 wrote that 'A general review of the evidence relating to the question of prohibition of ganja and charas brings the Commission to the same conclusion as that which they have framed upon a consideration of the evidence on the ascertained effects alone. The weight of the evidence above abstracted is almost entirely against prohibition. Not only is such a measure unnecessary with reference to the effects, but it is abundantly proved that it is considered unnecessary or impossible by those most competent to form an opinion on general grounds of experience; that it would be strongly resented by religious mendicants, or would be regarded as an interference with religion, or would be likely to become a political danger; and that it might lead to the use of dhatura or other intoxicants worse than ganja.' This was precisely what the ruling dispensation wanted to hear, and what they hoped to achieve. Mr. Monteath, Collector, in his evidence to the Hemp Commission said: "I think the present system of excise administration in respect of hemp drugs has worked fairly well, but that the time has come for putting these drugs on the same footing as alcoholic stimulants and opium." This is despite being fully aware that alcohol and opium were predominantly used by the ruling and upper classes, whereas the vast majority of India's population belonging to the poorest classes - including the laboring and working classes - used ganja and bhang as their intoxicant, medicine, source of income and spiritual aid. Mr. Ebden, Collector, said: "The hemp drugs are very much cheaper than liquor now. For a pice a man can get enough ganja to last him for a week if he is a moderate consumer. There is, therefore, considerable margin for heavier taxation of the drug without driving the people to liquor or other intoxicants. I consider there is a considerable margin for taxation, though the drug is consumed by the very poor. I have no sympathy with the excessive consumer, and the moderate consumer would not feel a moderate increase." Mr. Sinclair, Collector, said: "I consider there is a margin for increasing taxation, having regard to the price of other intoxicants, the fact that the drugs are mainly used by the poor, and the danger of smuggling." We can find open bias against cannabis, and in favor of opium, in some witness statements and governmental reports. For example, the evidence of Babu Gobind Chandra Das, Baidya, Deputy Magistrate and Deputy Collector, Malda, to the Hemp Commission states that "Mr. Grant, Collector of Balasore, observes (see Bengal Excise Administration Report for 188384):— 'I can only regard this rapid increase in the use of ganja as altogether lamentable. It is the only exciseable article in favour of which nothing can be said. It seems to have absolutely no virtue, and to do harm the very first time it is used. In shorter time than any other intoxicant, it establishes a craving habit, and is more irresistible than that created by any other. I cannot believe that the dearness of opium has done much to increase the consumption of ganja, and most unfortunately the price of ganja, which was very cheap before, has fallen during the year. I said last year that I thought it regretable that the price of opium has been raised. I can only repeat my opinions; at all events as far as Orissa is concerned, the measure is a bad one as regards the morality of the districts and as regards the revenue. For the past two years the local consumption of opium (a dear drug yielding a high revenue, a medical drug, hurtful only if abused) has greatly decreased, and its place has been supplied by a cheap drug that has nothing but the most seriously bad result from any use of it at all. Under ordinary circumstances, it is desirable to discourage the use of ganja by making its price as high as it can safely be made; but, under the circumstances of Orissa, it seems to me to be very unwise to do what amounts to forcing people to the extended use of most pernicious and cheap and accessible drug by putting what becomes a prohibitive price on the use of a very dear, comparatively harmless and often useful drug. If the thing is possible, I would reduce the price of opium in Orissa to what it was in 1879-80, and I would also raise the duty on ganja from R4 to R5.' Though there would be few to agree with Mr. Grant for lowering the price of opium, I think everyone would endorse his views on the effects of ganja-smoking. In fact, in the next line we find. 'The Commissioner agrees with Mr. Grant in his condemnation of ganja, and is in favour of the duty being raised.' In the preceding year Mr. Grant had delivered himself as follows on the subject:— 'I am afraid that this (increase in the consumption of ganja and decrease in that of opium) is something very like an unmixed evil. It means that people are substituting ganja,— a cheaper and infinitely more mischievous and deleterious drug. Instead of consuming maunds 3—11 of comparatively harmless opium the people consumed maunds 3—27—11 and 1/2 of ganja, which is, beyond all comparison, the drug which has least to be said in its favour and most to be against it. I strongly advocate a return to the old rate for opium, not because the new rate has so materially decreased the revenue, but because it is fast driving the people of Balasore to that resort to ganja which we know to be the root of the evils in the Uriya character.' Extreme views on a subject of this kind should no doubt be accepted with caution. But when we find that there has, for a long series of years, always been a consensus of opinion amongst persons who had the best opportunities to study the question, I think that opinion cannot be thrown aside easily. Elsewhere I have quoted from several published reports of Government how Government, the Board, and the subordinate officials have always spoken against ganja, and how they considered that it would be a blessing for the people if they were to substitute alcohol for ganja. Here I shall content myself with two or three more quotations in support of my views, Let us see what His Honour the LieutenantGovernor says so long ago as 1874. Reviewing the excise administration of 1873-74, His Honour says as follows (vide page 3 of the resolution appended to the report):— 'The Member in charge does not think that the time has yet arrived for any further increase of the duty. It appears, however, to the LieutenantGovernor that, of all excisable articles, the imposition of an almost prohibitive duty on ganja admits of the best justification upon both moral and economical grounds. It is generally agreed that even the moderate consumption of ganja is deleterious, and that its use leads to crime, to insanity, and other dreadful consequences. The conditions of its production are such that surreptitious cultivation appears scarcely to be possible. The cultivation of the ganja plant is not, like that of the poppy, spread over an extensive area. The whole of Bengal is supplied with ganja from a tract not exceeding 800 acres in Rajshahi. Supervision is consequently easy, and the imposition of a higher duty, if it resulted in a loss of revenue, would do so only by diminishing consumption. For the sake of the people, the Lieutenant-Governor earnestly commends this subject to the consideration of the Board.' Let us now see what the Bengal Excise Commission says on this subject— 'It is to be regretted, however, that this is due to some extent to the use of the pernicious drug ganja in these tracts.' Let us again see what the Government of India says— 'Ganja is a drug which is far more injurious in its effects than spirit or any other drug commonly consumed.'—(Despatch to the Secretary of State, No. 29 of 1890, dated Calcutta, the 4th February 1890.)" At the time that the Indian Hemp Commission was conducting its work in 19th century India, Burma (now Myanmar) was the only place where cannabis insanity had been stated as the justification for cannabis prohibition, based on the statistics from the Dacca Asylum. These statistics were produced and quoted by the asylum superintendent, Surgeon-Lieutenant-Colonel Crombie, in numerous instances, including before the Opium Commission, to emphasize that cannabis was most deleterious. Burma (now Myanmar) was, and still is, a vital conduit for opium trade between China and Britain, and that there were more than a few Chinese and British who viewed cannabis as a threat. The Commission states that 'Although these [lunatic asylum] statistics have been discussed seriously from year to year, they have not been much used as the basis of measures of ganja administration except in the case of Burma. In this case the Commission found that the measures taken in Burma were ostensibly based on the lunatic asylum returns which were quoted by more than one Chief Commissioner, special reference being made to the figures for the Dacca Asylum. This special reference to this asylum and the fact that it is situated in the most important ganja-consuming tract in India were among the reasons why the Commission summoned Surgeon-Lieutenant-Colonel Crombie (Bengal witness No. 104) as a witness; for he had been seven years Superintendent of that asylum. Before the Opium Commission also, and in an interesting discussion on opium published as a Supplement to the Indian Medical Gazette of July 1892, Dr. Crombie had incidentally spoken strongly of the evil effects of hemp drugs as seen in his asylum experience. The Commission hoped therefore that Dr. Crombie might be found to have devoted special attention to his asylum work, and to be able to speak with exceptional authority. He informed the Commission in his written evidence that "nearly thirty per cent. of the inmates of lunatic asylums in Bengal are persons who have been ganja smokers, and in a very large proportion of these I believe ganja to be the actual and immediate cause of their insanity." On oral examination by the Commission of Dr. Crombie, who used the Dacca asylum statistics to justify cannabis as a cause for insanity, it was found that 9 of the 14 cases attributed to cannabis insanity were inaccurate, and the remaining 5 appeared doubtful. Even if one considered the 5 cases, it only constituted 9% of the total cases and not the 30% that Dr. Crombie stated in his written evidence to the Commission.'

Key opium cultivation areas

India is the world's biggest producer of legal opium. Today, the illegal cultivation of opium globally is, of course, mainly concentrated in Myanmar, Afghanistan, Colombia and now Mexico. What is commonly seen is that the ruling entities in these countries ban the cultivation of opium for the farmers, and seize control over production, so that the regulated opium can be sold worldwide at high prices. In Afghanistan, the major opium consuming nations - the US, Russia and UK - have taken turns in invading and controlling the country. Recently, they outsourced the activity to the Taliban who does it these days, possibly selling at higher prices. Until recently, Afghanistan was the leading producer of illegal opium. UNODC states that 'In line with the dominance of the opium production in Afghanistan, quantities of heroin and morphine seized related to Afghan opiate production accounted for some 84 per cent of the global total in 2018, a slight decrease from 88 per cent in 2017, the year of the bumper harvest in the country. Most of the heroin found in Europe, Central Asia/ Transcaucasia and Africa is derived from opium of Afghan origin, accounting for 100 per cent of all mentions in the responses to the annual report questionnaire by countries in Central Asia/Transcaucasia, 96 per cent in Europe and 87 per cent in Africa over the period 2014–2018.' Regarding Myanmar, UNODC says, in its World Drug Report 2020 'The most significant trafficking activities worldwide of opiates not of Afghan origin concern opiates produced in South-East Asia (mostly Myanmar), which are trafficked to other markets in East and SouthEast Asia (mostly China and Thailand) and to Oceania (mostly Australia). Seizures made in those countries accounted for 11 per cent of the global quantities of heroin and morphine seized (excluding seizures made by Afghanistan) in 2018, down from 15 per cent in 2015.' Myanmar recently, in December 2023, upstaged Afghanistan as the key illegal opium producer. In Myanmar, the army has taken control over opium cultivation, definitely working in conjunction with Chinese entities to ensure that the product meets the right user, usually a wealthy person in the west. All these countries create smoke screens, in the form of terrorism and conflict, to establish control over opium supplies. In this way the control of opium, much like the control of petroleum, lies in the hands of the global rich and powerful. With these moves, the rich ensure that their global supply of opium never stops. In terms of raw legal opium, INCB writes further that 'The main countries importing opium in 2018 were Japan (36 tons, or 67.3 per cent) followed by France (11.1 tons, or 20.7 per cent) and the Islamic Republic of Iran (5 tons, or 9.3 per cent). The United States, which had been the main importer of opium, reported the import of only a negligible amount of opium from India in 2018.' The Colombian and Mexican drug cartels, working in conjunction with government and US entities, ensured that the US received a steady supply of heroin. These days, Mexican drug cartels ensure that there is enough fentanyl available for the US as well.

Opium cultivation, I believe, is managed by global opium cartels, much like oil production is managed by the oil producing nations. I believe that the Taliban and the military ruling Myanmar are just puppets being instructed by the opium cartel based out of North America, Europe, Iran, India and China in terms of how much opium to produce. Through this management, these entities determine how much opium must be cultivated in which source country, so as to keep the supply and prices of opium within their desired ranges, ensuring that the rich get their opium, and also get rich getting their opium. UNODC says that 'Despite global opium production in 2018 being less than in 2017, there have been no indications to date of a shortage in the supply of heroin to the respective consumer markets. In 2018 and 2019, both opium and heroin prices declined in the main opium production areas in Afghanistan, with opium farmgate prices falling by an average of 37 per cent (on a year earlier) in 2018 and by 24 per cent in 2019, while high-quality heroin prices fell by an average of 11 per cent in 2018 and by 27 per cent in 2019 in Afghanistan. Due to the bumper opium harvest of 2017, opium prices showed significant declines at an earlier stage (starting in 2017) than did heroin prices (basically starting in 2018), suggesting that it may have taken some time for clandestine heroin manufacture to adjust to the overall greater availability of opium before expanding, as later reflected in lower heroin prices. At the same time, data also show that, following two years of decreased opium production as compared with 2017, the downward trend in drug prices came to a halt, in the case of opium, in June 2019, and a few months later, in August 2019, in the case of heroin as well.' It says that 'Despite a long-term upward trend, the global area under opium poppy cultivation declined by 17 per cent in 2018 and then by 30 per cent in 2019, falling to an estimated 240,800 ha. Declines in the area under cultivation were reported in both Afghanistan and Myanmar in 2018 and 2019. Despite the recent declines, the global area under opium poppy cultivation is nevertheless still substantially larger than a decade ago and at similar level of the global area under coca cultivation.' The falling prices of opium and heroin, due to the bumper harvests in Afghanistan fueled by increasing poppy cultivation by farmers, appears to have prompted the global opium cartel to reinstate the Taliban as the puppet rulers of Afghanistan so as to ensure tighter regulation of poppy cultivation. The Taliban promptly cracked down on poppy cultivation. In fact, it did such a good job that Myanmar has now taken over as the biggest illegal opium producing nation. The military in Myanmar, with their strings pulled by China, keep the Myanmar opium cultivation regulated. I would not be surprised to see changes in the military leadership in Myanmar if there is a flood of opium crop from Myanmar driving down prices of opium and heroin in the market. In India, the crackdown on the Kukis in Manipur also appears to be a result of an attempt by the global opium cartel to prevent small farmers from increasing poppy cultivation, and thus flooding the market with bumper crops that will drive down the prices of opium. This will significantly affect the revenues for all concerned, including the Indian government which is essentially the ruling political party, the BJP. The three biggest source countries however dominate cultivation. UNODC says that 'Opium is illicitly produced in some 50 countries worldwide, although the three countries where most opium is produced have accounted for about 97 per cent of global opium production over the past five years. Afghanistan, the country where most opium is produced, which has accounted for approximately 84 per cent of global opium production over the past five years, supplies markets in neighbouring countries, Europe, the Near and Middle East, South Asia and Africa and to a small degree North America (notably Canada) and Oceania. Countries in SouthEast Asia – mostly Myanmar (some 7 per cent of global opium production) and, to a lesser extent, the Lao People’s Democratic Republic (about 1 per cent of global opium production) – supply markets in East and South-East Asia and Oceania. Countries in Latin America – mostly Mexico (6 per cent of global opium production) and, to a far lesser extent, Colombia and Guatemala (less than 1 per cent of the global total) – account for most of the heroin supply to the United States and supply the comparatively small heroin markets of South America.' I suspect that the global opium cartel seamlessly switches opium supplies between legal and illegal markets, depending on the demand for the various opium derivatives, available supply, and the potential for profit. So, if there is a shortage of heroin in the illegal market, it will be diverted from the legal sources to meet the demand. Similarly, if there is a shortage of morphine in the legal pharmaceutical market, it will be diverted from the illicit market to meet demand. This seamless interplay between legal and illegal sources and markets ensures that demand, supply and prices are kept at an optimum to ensure maximum profit.

Opium processing and distribution

The processing of opium is complex, with different stages of processing being done in different parts of the world, often far removed from the source regions cultivating the plant. For example, raw opium is procured legally or illegally from Afghanistan, Myanmar, Colombia, Mexico and India and processed into morphine in France, heroin in the UK, tramadol in India, etc. The source countries also process opium into heroin or morphine. UNODC says that 'Most opiates seized are reported in or close to the main opium production areas. Thus Asia, host to more than 90 per cent of global illicit opium production and the world’s largest consumption market for opiates, accounted for almost 80 per cent of all opiates seized worldwide, as expressed in heroin equivalents, in 2018.' UNODC, in its World Drug Report 2020, further states that 'Almost 70 per cent of the global quantities of heroin and morphine (the two main internationally trafficked opiates) seized in 2018 were intercepted in Asia, mostly in South-West Asia. The two subregions surrounding Afghanistan, South-West Asia and Central Asia, together accounted for more than 56 per cent of the global quantity of heroin and morphine seized. Despite the decline in 2018, the overall trend in seizures of heroin and morphine in that subregion continued to be an upward one over the period 2008–2018. South-West Asia continued to account for the majority of the global quantities of heroin and morphine seized globally in 2018 (close to 56 per cent), with the largest quantities seized being reported by the Islamic Republic of Iran, followed by Afghanistan and Pakistan.' UNODC further states that 'The largest quantities of both opium and morphine seized were reported by the Islamic Republic of Iran, followed by Afghanistan and Pakistan, while seizures reported by other countries remained comparatively modest. The largest total quantity of heroin seized by a country in 2018 was that seized by the Islamic Republic of Iran (for the first time since 2014), followed by Turkey, the United States, China, Pakistan, Afghanistan and Belgium.' It further says that 'The largest quantities of opiates continued to be seized in South-West Asia in 2018, accounting for 98 per cent of the global quantity of opium seized, 97 per cent of the global quantity of morphine seized and 38 per cent of the global quantity of heroin seized that year (i.e., equivalent to 70 per cent of all opiates seized globally as expressed in heroin equivalents). Overall, 690 tons of opium, 42 tons of morphine and 37 tons of heroin were seized in South-West Asia in 2018.' The myriad criss-crossing of opium, in its raw, processed and finished states, happens between numerous countries. Seizure happens mostly in neighbouring countries to the source. UNODC reports that 'The quantities of opium and morphine seized continued to be concentrated in just a few countries in 2018, with three countries accounting for 98 per cent of the global quantity of opium seized and 97 per cent of the global quantity of morphine seized. By contrast, seizures of heroin continue to be more widespread, with 54 per cent of the global quantity of heroin seized in 2018 accounted for by the three countries with greatest seizures.' UNODC says that 'The opiate seized in the largest quantity in 2018 continued to be opium (704 tons), followed by heroin (97 tons) and morphine (43 tons). Expressed in heroin equivalents, however, heroin continued to be seized in larger quantities than opium or morphine. Globally, 47 countries reported opium seizures, 30 countries reported morphine seizures and 103 countries reported heroin seizures in 2018, suggesting that trafficking in heroin continues to be more widespread in geographical terms than trafficking in opium or morphine.' INCB reports that 'In 2018, the main countries reporting utilization of opium for the extraction of alkaloids were the Islamic Republic of Iran (511.8 tons, or 56.3 tons of morphine equivalent), India (138.5 tons, or 15.2 tons in morphine equivalent) and Japan (41.6 tons, or 4.6 tons in morphine equivalent). The opium reported as utilized by the Islamic Republic of Iran originated from seized material.' Finally the best heroin reaches the richest customers in the world, usually in North America and Europe. The richest people in the world get the best product - pure heroin. As one climbs down the social and economic ladder, the product available becomes more and more close to the raw opium. So, the next rung of the rich and powerful get morphine, hydrocodone and oxycodone. A lower rung gets tramadol and codeine. Among the lowest rungs, opium as raw product - in paste or straw form is consumed.

There are dedicated routes through land, sea, and increasingly air, which supply the processed opium to North America, Europe, Africa, the Far East and Oceania. Even though the Middle East reports opium consumption and seizure, its preferred poison is stimulants, mainly the amphetamine type substances. The United Nations Office on Drugs and Crime, World Drug Report 2020, states that 'Most heroin (and morphine) trafficking in the Americas continues to take place within North America, i.e., from Mexico to the United States and, to a far lesser extent, from Colombia and from Guatemala (typically via Mexico) to the United States. Based on forensic profiling, United States authorities estimated in 2017 that over 90 per cent of the heroin samples analysed originated in Mexico and 4 per cent in South America, while around 1 per cent originated in South-West Asia. This stands in stark contrast to a decade earlier (2007), when only 25 per cent was sourced from Mexico and 70 per cent was imported from South America.' UNODC further states that 'Heroin trafficking in the Americas remains concentrated in North America. The subregion accounted for 94 per cent of all quantities of heroin and morphine seized in the Americas in 2018, when seizures reported in North America were almost four times as high as a decade earlier. Seizures made in the United States accounted for 87 per cent of all heroin and morphine seized in the Americas in 2018, followed by Mexico (the country where most opium is produced in the region), Colombia, Ecuador, Brazil, Canada and Guatemala.' After the US, the biggest market for heroin is Europe, the other set of nations that are proud to be rich. UNODC, in its World Drug Report 2020, says that 'The largest total quantity of heroin and morphine seized in a region outside Asia is that reported for Europe (22 per cent of the global total in 2018), which is an important market for the consumption of heroin. Heroin and morphine seized in Eastern and South-Eastern Europe continued to account for the bulk (66 per cent) of all such quantities seized in Europe in 2018, with most of the heroin and morphine seized in the region continuing to be reported by Turkey (62 per cent), followed by Western and Central Europe (31 per cent) and Eastern Europe (3 per cent) in 2018.' UNODC, in its World Drug Report 2020, speaks about the heroin route to Europe, stating that 'The main countries identified in which heroin was trafficked along the southern route to Western and Central Europe over the period 2014– 2018 included India, the Gulf countries (notably Qatar and United Arab Emirates) and a number of Southern and East African countries (notably South Africa, Kenya, Ethiopia, Mozambique, the United Republic of Tanzania, Rwanda, Burundi, Uganda and Madagascar). The European countries reporting most trafficking along the southern route over the period 2014–2018 were Belgium (mostly via Kenya, Burundi, Rwanda, Uganda, South Africa, Ethiopia and the United Republic of Tanzania) and Italy (mostly via Qatar, the United Arab Emirates, South Africa, Ethiopia, Madagascar and Oman).' UNODC further reports that 'The Islamic Republic of Iran reported that 75 per cent of the morphine and 75 per cent of the heroin seized on its territory in 2018 had been trafficked via Pakistan, while the remainder had been smuggled directly into the country from Afghanistan. Typically, heroin is then smuggled to Turkey (70 per cent of all the heroin seized in the Islamic Republic of Iran in both 2016 and 2017) and from there along the Balkan route to Western and Central Europe, either via the western branch of the route via Bulgaria to various western Balkan countries or, to a lesser extent, via the eastern branch of the route via Bulgaria and then to Romania and Hungary, before reaching the main consumer markets in Western and Central Europe'. The main route for the flow of heroin into Europe from Asia is the Balkan route. This route is probably the oldest route, having served to supply opium from China and Afghanistan to UK and the rest of Europe for centuries. UNODC says that 'The world’s single largest heroin trafficking route continues to be the so-called “Balkan route”, along which opiates from Afghanistan are shipped to Iran (Islamic Republic of), Turkey, the Balkan countries and to various destinations in Western and Central Europe. Not counting seizures made in Afghanistan itself, countries along the Balkan route accounted for 58 per cent of the global quantities of heroin and morphine seized in 2018. A further 8 per cent of those global seizures were reported by countries in Western and Central Europe, whose markets are supplied to a great degree by heroin and morphine that is trafficked along the Balkan route' Besides the Balkan route, heroin flows from the Middle East into Europe by sea as well. UNODC says that 'In contrast to Western and Central Europe as a whole, which continues to be supplied mainly by heroin trafficked along the Balkan route by land, trafficking to Belgium in 2018 to a large extent (98 per cent) took the form of maritime shipments departing from the Islamic Republic of Iran or Turkey. Similarly, trafficking to Italy was characterized by maritime shipments in 2018 (61 per cent of the total quantity seized by customs authorities), with the bulk of seizures in 2018 having departed from the Islamic Republic of Iran in containers, followed by shipments by air (37 per cent), often departing from the Middle East (Qatar) or Africa (South Africa), while heroin shipments destined for France typically transited the Netherlands and Belgium in 2018'. It appears that it takes about a year for harvested opium to be converted into heroin, and to finally reach the markets. UNODC reports that 'While the strongest increase in the quantities of heroin and morphine seized in 2017 was reported in Eastern and South-Eastern Europe (the same year as the bumper opium harvest reported in Afghanistan), the strongest increase in 2018 was reported in Western and Central Europe (89 per cent). This suggests that it may take a year from when opium is harvested in Afghanistan until it is manufactured into the heroin that ends up on the streets of Western and Central Europe. There were increases in heroin and morphine seizures in Europe in the countries along the Balkan route in 2018, although most of the increase was due to an increase in the quantities of heroin and morphine seized in Belgium and, to a lesser extent, in France and Italy.'

The roles played by the pharmaceutical and medical industry

The world wide proliferation of opium could not have been achieved without the roles played by the pharma industry and medical industry. One entity writes the prescription scripts, and the other entity supplies the opium. Together, they ensure that governments get a big cut of the profits, thus ensuring that things remain rosy and that no threat to the global opium industry materializes. The scientific journal, Nature reports that 'Large-scale surveys show that there is a similar prevalence of pain in France and Italy as there is in the United States. But according to data from the United Nations, US doctors write five and a half times more prescriptions for opioids than do their counterparts in France, and eight times more than do physicians in Italy. Humphreys says that this might be because people in the United States expect to receive a prescription when they go to the doctor with a health concern. Meanwhile, direct advertising of pharmaceuticals to consumers (permitted only in the United States and New Zealand) encourages them to ask doctors for specific drugs.' The doctors themselves seem to be addicted to the opium that they prescribe. This accounts for their staunch support of opium, and opposition to cannabis legalization. The Hindu reports that '“Long stressful work hours, easy access to painkillers and drugs such as Morphine, a habit of self-diagnosis and self-medication — that is, unwillingness for a doctor to be the patient — are contributing factors for doctors taking up tobacco or other drugs,” he said, adding that a recent study showed that 43 per cent of doctors who admitted using opioids had kept it hidden from society for over two years.' William S Burroughs writes in his book Junk - 'Generally speaking, old doctors are more apt to write than the young ones. Refugee doctors were a good field for a while, but the addicts burned them down.' He says 'There are several varieties of writing croakers. Some will write only if they are convinced you are an addict, others only if they are convinced you are not. Most addicts put down a story worn smooth by years of use. Some claim gallstones or kidney stones. This is the story most generally used, and a croaker will often get up and open the door as soon as you mention gallstones. I got better results with facial neuralgia after I had looked up the symptoms and committed them to memory. Roy had an operation scar on his stomach that he used to support his gallstone routine.' Burroughs further writes in his book, Junk - 'He located a doctor in Brooklyn who was a writing fool. That croaker would go three scripts a day for as high as thirty tablets a script. Every now and then he would get dubious on the deal, but the sight of money always straightened him out.' UNODC reports that 'The rate of prescription of opioids in the United States fell to 51.4 prescriptions per 100 persons (a total of more than 168 million opioid prescriptions) in 2018 from a peak of 81.3 opioid prescriptions per 100 persons (or 255 million opioid prescriptions) in 2012. The opioid prescription rate in the southern United States remains high, however, with most states in the region reporting opioid prescription rates of 64 or more per 100 persons in 2018. A number of factors at work, including advertising by the pharmaceutical industry, physicians’ prescription practices, dispensing and medical culture and patient expectations have, since the new millennium, resulted in high prescription rates and dosages of opioids given for an extended duration of care, primarily for the management of acute to chronic non-cancer pain. These practices have also enabled the diversion and misuse of pharmaceutical opioids, together with a greater risk of opioid use disorders among those with a legitimate prescription.' As an example of the role played by the pharmacist in fueling the opium crisis, William S Burroughs writes 'We were having trouble filling the scripts. Most drugstores will only fill a morphine script once or twice, many not at all. There was one drugstore that would fill all our scripts anytime, and we took them all there..' Toronto Life reports that 'Like many pharmacists in Ontario, El-Azrak needed a physician nearby to write the prescriptions that would make up the backbone of her business. Otto had visited her pharmacy before, and she wanted to form a partnership. It was a common arrangement between doctors and pharmacists: she’d send him patients, he’d send her scripts.'

Opium for managing the pain of the elites

The primary alleged medical use of opium is for pain relief. But its addictive nature is so strong that eventually a user will become addicted to it. Not only that, the user starts seeking more and more powerful alternative opium products as the tolerance levels increase. So it appears that a common path of opioid addiction is through prescription opioids, non-medical use of prescription opioids, and then eventually heroin and fentanyl, if one is rich enough. Nature reports that 'The opioid epidemic has had three phases: the first was dominated by prescription opioids, the second by heroin, and the third by cheaper — but more potent — synthetic opioids such as fentanyl. All of these forms of opioid remain relevant to the current crisis. “Basically, we have three epidemics on top of each other,” Humphreys says. “There are plenty of people using all three drugs. And there are plenty of people who start on one and die on another.”' Science Direct reports that 'This study investigates prior prescription opioid misuse in a cohort of heroin users whose progress was tracked in a treatment study conducted in the US from 2006 to 2010. Half of the sample misused prescription opioids (“other opiates/analgesics”) prior to their onset of heroin misuse (POBs). We found that POBs were demographically younger and more likely to be white than other heroin users (OHUs). There were differences between the two groups with respect to the reporting of at least one year of regular use of substances and age of onset of substance use. POBs were more likely to report regular use, and earlier onset of use of several substances, mostly of the type potentially obtained via prescription. POBs were more persistent in their opioid use and more likely to suffer near-term elevated depressive symptoms compared with OHUs. These findings suggest that heroin addiction treatment may need to be tailored according to opioid misuse history.' And opium is not even supposedly good at its primary function of pain removal. As Nature reports - 'In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. And the claim that OxyContin was less addictive than other opioid painkillers was untrue — Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a US$635 million fine for the company. But doctors and patients were unaware of that at the time.' Despite all the evidence that is there regarding the effectiveness of cannabis for treating pain, and the widespread evidence of the harmfulness of opioids, the medical and scientific community continues to favor opioids. UNODC reports that 'Moreover, many of the studies have overlooked the proliferation of fentanyl as a driver of opioid overdose mortality in the United States, which may negate any potential effect of medical cannabis on overdose deaths. It can only be concluded that additional research might help to identify a range of alternative non-opioid medications and non-pharmacological treatments that could be effective in pain management. The issue of whether increased accessibility of cannabis could reduce the medical and non-medical use of pharmaceutical opioids and their negative impact remains inconclusive.' If there is not enough traction in the adoption of cannabis as pain medicine, it is the medical community largely responsible for the opioid crisis, that is to blame. UNODC reports that 'The use of strong opioids, especially morphine, is generally considered the principal treatment for the management of pain in palliative care for cancer patients. The treatment of chronic non-cancer pain, which is among the most prevalent health conditions in many countries, is often considered more difficult to manage, and its treatment is sometimes more controversial. Chronic non-cancer pain is defined in scientific literature as pain lasting for more than three months that stems from injuries or illnesses other than cancer. It is also considered that chronic pain results from a combination of biological, psychological and social factors, and thus requires a multifactorial approach to pain assessment, patient monitoring and evaluation and long-term management. Some of the common conditions that cause chronic pain include neuropathic pain, fibromyalgia that may be caused by damage to the peripheral or central nervous system, low back pain and osteoarthritis.' Morphine is, however available only to the rich. Cannabis is one of the most effective medicines for both pain relief and inflammation. Most pain medicines do not address the inflammation aspect. Cannabis is effective for physical pain - short term or chronic, as well as for mental pain and anguish. Today, one of the main uses of cannabis, in places where it has been legalized for medical purposes, is for the treatment of pain. In 19th century India, the Indian Hemp Drugs Commission of 1894-95 reports that one of the primary medical uses of cannabis was for the treatment of pain. The Commission says that 'In connection with the therapeutics of hemp drugs, one of the commonest uses is for the relief of pain, the drugs being used either as local or general anodynes. Thus bhang poultices are frequently mentioned as soothing local applications to painful parts; and poultices are used for inflamed piles and over the seat of pain in liver and bowel diseases, and to check inflammation and erysipelas. Fumigation with the smoke from burning ganja or bhang is also used as a local sedative in piles. A small fragment of charas is placed in a carious tooth to relieve toothache. And the use of the drugs is also referred to for the relief of protracted labour pains, dysmenorrhœa, pain in the stomach, cramps, and neuralgia. One witness states that hemp drugs are used as a substitute for opium. In cases of circumcision the drugs are used as anæsthetics, and a witness mentions that native doctors on rare occasions substitute ganja for chloroform in operations. The tincture of Cannabis has been used as a local anæsthetic in extracting teeth (British Journal of Dental Science).'

Legal prescription opioids are only available to the world's rich, whereas cannabis, possibly the best natural medicine for pain, is banned world wide leaving the world's poor with nothing for their pain. UNODC reports that 'Medicines for pain relief are unequally distributed across regions. More than 90 per cent of all pharmaceutical opioids available for medical consumption were in high-income countries in 2018. Some 50 per cent were in North America, 40 per cent in Europe, and a further 2 per cent in Oceania. Those countries are home to about 12 per cent of the global population. Low- and middleincome countries, which are home to 88 per cent of the global population, are estimated to consume less than 10 per cent of pharmaceutical opioids.' UNODC says that ' Moreover, because of the high cost of pain medications, in many high-income countries and in most low- and middle-income countries, where a large number of people are not covered by either health insurance or a national health-care system, many people can encounter difficulties in accessing the pain medications that they need.' UNODC reports that 'At the global level, Germany was the second largest consumer of opioid pain relievers, with an estimated 28,862 S-DDD per million population per day for medical use in 2017, followed by Austria, Belgium and Switzerland. In Germany, the number of pharmaceutical opioids overall and the number of people receiving opioid treatment have increased over the past few decades; in most instances, prescriptions were given for non-chronic cancer pain. A review of scientific literature from Germany published between 1985 and 2016 showed that out of the 12 studies reviewed, 6 studies reported a prevalence for patients with medical use of any opioid for long-term treatment of non-cancer chronic pain ranging from 0.54 to 5.7 per cent, while four studies reported a prevalence for patients with medical use of opioids at 0.057 to 1.39 per cent of the population' Opioids, as pain medicine, are only available to a small fraction of the world's population i.e. the elites and upper classes. The rest of the world, which would vastly benefit from cannabis as accessible and affordable pain medicine for all, remain without either opioids or cannabis for its pain. UNODC reports that 'Access to and availability of controlled medicines for pain relief, i.e., opioids, are unequally distributed across the geographical regions and have had diverging trends in different regions. The amount of opioids (expressed in daily doses) available for consumption for medical purposes more than doubled globally over the period 1998–2010, followed by a period of stabilization and a decline over the period 2014–2018. Most of the increase in the amount of pharmaceutical opioids available for medical consumption over the period 1998–2010 was of oxycodone (which experienced a tenfold growth over that period), hydromorphone (fivefold growth), hydrocodone (threefold growth) and oxymorphone (46,000-fold growth). Methadone and buprenorphine, the opioids used in medically assisted treatment of opioid use disorders, also saw marked increases in the amounts available for medical consumption at the global level. The amount of fentanyl available for medical consumption rose ninefold over the period 1998–2010. Moreover, since 2000, only about 10 per cent of globally available morphine was reported to have been used for palliative care while over 88 per cent was converted into codeine, the majority of which (89 per cent) was used to manufacture cough medicines.' Not only is the availability of opioids for pain relief concentrated within wealthy regions, it is further concentrated in rich countries within the region. UNODC says that 'Even within each region or subregion, there is a significant disparity in the consumption of opioids for medical purposes. Over the period 2014–2018, average consumption of opioids in countries in North America ranged from some 100 defined daily doses for statistical purposes (S-DDD) per million inhabitants in Mexico to 32,700 S-DDD per million inhabitants in the United States of America. Similarly, in Western and Central Europe, estimates ranged from close to 500 S-DDD per million inhabitants in Malta to 25,800 S-DDD per million inhabitants in Germany. In Oceania, estimates ranged from, on average, 15 S-DDD per million inhabitants in Vanuatu to close to 11,600 S-DDD per million inhabitants in Australia, and in Asia, from 0.1 S-DDD per million inhabitants in Yemen to close to 11,300 S-DDD per million inhabitants in Israel.' Within poor countries, it is only the elite classes that have access to opium. As if the use of opioids that have wrecked havoc among the rich and upper classes is not enough, health experts seem to be happy to hear that its usage is slowly spreading among poorer countries. I attribute this increase in availability and usage by poorer nations to be the result of the increasing awareness of the dangers of opium among the world's wealthy. The movement of the rich and upper classes to cannabis for pain relief is driving legal and illegal pharmaceutical companies to now try and peddle their opium to the poorer nations. This is similar to how products banned in the west are subsequently marketed in other regions where the people are yet to come up to speed with the dangers of these products. UNODC reports that 'In recent years the huge disparity between countries in the accessibility of opioids for medical purposes has been reduced slightly: declines in opioids available for medical consumption are reported in North America, while overall increases are reported in several other subregions, most notably South America and the Near and Middle East/South-West Asia, where availability has been low. This suggests an overall increase in the availability of opioids in developing countries, although that availability was starting from, and remains at, a low level. Daily per capita availability of pharmaceutical opioids more than doubled in the regions and subregions where availability was below the global average (i.e., Africa, Asia, South America, Central America, the Caribbean, Eastern and South-Eastern Europe, Melanesia, Micronesia and Polynesia); taken together, availability in these regions and subregions increased from an average of 70 S-DDD per million inhabitants in 2010 to 180 S-DDD in 2018 (7 per cent of the global per capita average).' UNODC further reports that 'By contrast, the availability of pharmaceutical opioids for medical purposes declined by almost 50 per cent in North America, from 32,550 S-DDD per day per million inhabitants in 2010 to 16,910 S-DDD in 2018, thus approaching the levels reported in Western and Central Europe (12,660 S-DDD) and in Australia and New Zealand (10,530 S-DDD) in 2018. Nevertheless, per capita availability of pharmaceutical opioids for medical purposes in North America remains comparatively high (almost eight times the global average), in particular when compared with the extremely low levels in Africa and South Asia, as well as in Central Asia and Transcaucasia, where there are no signs of increases.'

The phrase 'opium of the masses' has no truth in it. The correct term would be 'opium of the elites' or 'cannabis of the masses', since it is the elites who use opium and the masses who use cannabis. Yes, maybe in opium growing areas the people involved in its cultivation may use opium, but, in general, it is only available for the rich upper classes. Cannabis, on the other hand, was the herb that was widely used by the world's majority population - its poor and working classes. This has changed a lot with cannabis prohibition, with only the rich being able to access and afford cannabis, while the only poor who can access it are those close to, or involved with, its cultivation. Despite this, at least 250+ million people globally use cannabis these days.

The hydra-like qualities of opium

Opium is like a hydra. One plant has created so many drugs that it boggles the mind. From opium comes morphine, heroin, codeine, oxycodone, hydrocodone, methadone, buprenorphine, tramadol, and so on. Each and every one of these drugs have created massive problems of their own.

Heroin, given its name for its apparent heroic qualities, when it was first synthesized from opium, soon became the number one drug of choice of the world's elites. Just as it was fashionable to be seen around cocaine, no elite worth his or her salt, felt complete without the mandatory association with heroin. Almost all the opium that gets converted to heroin ends up in the hands of wealthy nations, and the wealthy in all nations, primarily because it is only they who can afford heroin, and who revel in their association with heroin. Regarding the heroin that is manufactured legally by these rich countries, INCB reports that 'In 2018, a total of 1,342.3 kg of [licit] heroin was manufactured, mostly by the United Kingdom (924.8 kg, or 68.9 per cent of global manufacture), Switzerland (374.9 kg, or 27.9 per cent) and Spain (42.6 kg, or 3.2 per cent). The two main countries exporting heroin were the United Kingdom (313.0 kg, or 71.3 per cent of global exports) and Switzerland (118.3 kg, or 26.9 per cent). In 2018, the main importing country was the Netherlands (167 kg, or 38.4 per cent of global imports), followed by Switzerland (121.8 kg, or 28.0 per cent), Germany (54.4 kg, or 12.5 per cent), Denmark (39.3 kg, or 9.1 per cent), the United Kingdom (28.3 kg, or 6.5 per cent), Canada (16.5 kg, or 3.8 per cent) and Luxembourg (7.3 kg, or 1.7 per cent)' The UK has continued from its strategy of cornering the opium trade and eliminating cannabis, to becoming the leading manufacturer of legal heroin, besides obtaining it illegally from source countries. JAMA Network reports that 'We found that heroin use is not simply an inner-city problem among minority populations but now extends to white, middle-class people living outside of large urban areas, and these recent users exhibit the same drug use patterns as those abusing prescription opioids. In this connection, our data indicate that many heroin users transitioned from prescription opioids. The factors driving this shift may be related to the fact that heroin is cheaper and more accessible than prescription opioids, and there seems to be widespread acceptance of heroin use among those who abuse opioid products.' The US is, of course, the biggest market for heroin, and why not, considering the need to project the image of the world's richest, most powerful and influential nation, even if actual reality is something different.

Morphine, I consider as next, after heroin, in the ranking of opium based drugs when it comes to appeal to the rich. If the rich cannot get heroin, then they may settle for sister morphine. Wikipedia says that 'About 70 percent of morphine is used to make other opioids such as hydromorphone, oxymorphone, and heroin. Potentially serious side effects include decreased respiratory effort and low blood pressure. Morphine is addictive and prone to abuse.A large overdose can cause asphyxia and death by respiratory depression if the person does not receive medical attention immediately. One poor quality study on morphine overdoses among soldiers reported that the fatal dose was 0.78 mcg/ml in males (~71 mg for an average 90 kg adult man) and 0.98mcg/ml in females (~74 mg for an average 75 kg female). It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. According to a 2005 estimate by the International Narcotics Control Board, six countries (Australia, Canada, France, Germany, the United Kingdom, and the United States) consume 79% of the world's morphine. The less affluent countries, accounting for 80% of the world's population, consumed only about 6% of the global morphine supply.' INCB reports that 'In 2018, 79 per cent of the world population, mainly persons in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering. Although the situation improved in the previous 20 years, the disparity in consumption of narcotic drugs for palliative care continues to be a matter of concern, particularly in relation to access and availability of affordable opioid analgesics such as morphine. The remaining 87 per cent of the total consumption of morphine, excluding preparations in Schedule III of the 1961 Convention, continued to be concentrated in a small number of countries, mainly in Europe and North America. In 2018, European countries as a whole and the United States accounted for the highest share of global morphine consumption (39.5 per cent and 39.3 per cent respectively); they were followed by Canada (5.1 per cent), Australia and New Zealand (2.5 per cent) and Japan (0.6 per cent).' Again the country with both the most imports, as well as the most exports of legal morphine was the UK. INCB writes that 'The main importing countries [of morphine] in 2018 were the United Kingdom (5.0 tons, or 19.6 per cent), Germany (4.5 tons, or 17.6 per cent), Austria (2.5 tons, or 9.9 per cent), Hungary (2.1 tons, or 8.3 per cent), Canada (1.7 tons, or 6.8 per cent), Australia (1.6 tons, or 6.1 per cent) and Switzerland (1.3 tons, or 5.2 per cent). Other countries imported less than 1 ton of morphine.' It further reports that 'Morphine exports decreased to 23.4 tons in 2016, before increasing again, to 28.1 tons, in 2017 and then decreasing again, to 24.7 tons, in 2018. The main exporting countries in 2018 were the United Kingdom (31.6 per cent), France (15.4 per cent), Switzerland (9.8 per cent), Germany (9.4 per cent), Australia (7.9 per cent), Italy (6.9 per cent) and the United States (6.6 per cent). Other countries accounted for less than 2 per cent of total exports of morphine.' In terms of manufacturing, INCB reports that 'In 2018, the leading morphine manufacturing country was France (86.4 tons, or 22.3 per cent of global manufacture), followed by the United Kingdom (83.7 tons, or 21.6 per cent), Australia (50.5 tons, or 13 per cent), the Islamic Republic of Iran (38.5 tons, or 9.9 per cent), Norway (21.1 tons, or 5.4 per cent), China (18.2 tons, or 4.7 per cent), the United States (17.7 tons, or 4.6 per cent), Japan (16.4 tons, or 4.2 per cent), Spain (13.1 tons, or 3.4 per cent) and India (12.0 tons, or 3.1 per cent). Together, those 10 countries accounted for 92.2 per cent of global manufacture of morphine.' INCB reports that Turkey was the leading nation for morphine manufacture from poppy straw in 2018. It states 'In 2018, the main countries utilizing poppy straw (Morphine) were Turkey (17,253.0 tons in gross weight), Spain (7,384.5 tons), France (5,710.1 tons), Australia (3,452.3 tons), Slovakia (1,644.4 tons) and China (1,361.7 tons). Belgium and North Macedonia each utilized less than 1,000 tons of poppy straw (M) in 2018.' Morphine is especially popular with the rich because they also indulge in cocaine. Morphine helps to keep the rich from getting over stimulated and having heart attacks. As William S Burroughs writes in Junk - 'C[ocaine] is hard to find in Mexico. I had never used any good coke before. Coke is pure kick. It lifts you straight up, a mechanical lift that starts leaving you as soon as you feel it. I don't know anything like C for a lift, but the lift lasts only ten minutes or so. Then you want another shot. You can't stop shooting C - as long as it is there you shoot it. When you are shooting C, you shoot more M[orphine] to level the C kick and smooth out the rough edges. Without M, C makes you too nervous, and M is an antidote for an overdose. There is no tolerance with C, and not much margin between a regular and a toxic dose. Several times I got too much and everything went black and my heart began turning over. Luckily I always had plenty of M on hand, and a shot of M fixed me right up.' UNODC reports that 'In 2018, 87 per cent of the global amount of morphine available for medical consumption was estimated to have been consumed in high-income countries, which are home to 12 per cent of the global population. While the relative importance of the amounts of morphine available for medical consumption in low- and middle-income countries has increased slightly since 2014 (from 9.5 to 13 per cent in 2018) the amount of morphine available per person per country is still infinitesimally small to non-existent in many developing countries, particularly in South Asia and in Africa. Even though countries may have morphine available for medical use, many people still have limited access to it. WHO estimates that globally, each year 5.5 million terminal cancer patients and 1 million end-stage HIV/AIDS patients do not have adequate treatment for moderate to severe pain.'

When the opium cartel decided to distribute the global responsibility for pushing each variant of opium among various countries, it gave India tramadol to work with and push. India goes about manufacturing tramadol in abundance and pushing it to vulnerable populations within the country, as well as to markets in Africa and South East Asia. Tramadol, and codeine, appear to be the only kind of opioids that poor countries can hope to afford. Heroin, morphine, oxycodone and hydrocodone are for the rich. CSIS reports that 'In the Middle East and Africa, the less potent opioid tramadol, not fentanyl, is responsible for the opioid crisis. India is the biggest supplier.' UNODC reports that 'In Africa, the increasing proportion of people treated for opioid use disorders likely reflects the increasing use of opioids, especially tramadol, in West and Central Africa. In that subregion, opioids (heroin and tramadol) were, after cannabis, the second most common drug type for which people accessed drug treatment services over the period 2014–2017.' UNODC further reports that 'The trafficking and availability of tramadol for its non-medical use is a public health concern, but limited distribution of tramadol for medical use would also pose a public health concern, in particular in Africa, where there is a chronic shortage of pain medications. There are no data on the availability and use of tramadol for medical purposes, but data on internationally controlled substances clearly highlight the gaps in the accessibility of pain medications. The general lack of access to opioid-related pain medications under international control is a specific problem for developing countries, which is even more pronounced in countries in West and Central Africa than in other parts of the world. Against this background of a de facto non-availability of internationally controlled opioids for pain medication for large sections of the population in West and Central Africa, tramadol – even though it is under national control in some West African countries – is in fact a widely available opioid in those countries, used for both medical purposes (including outside prescription) and for non-medical purposes.' UNODC says 'With the exception of Nigeria, where 4.6 million people were estimated to have used opioids – mainly tramadol – in 2017, population-level prevalence estimates of the use of opioids are not available for countries in West, Central and North Africa. However, many countries in those subregions report high levels of non-medical use of tramadol. For example, in Egypt, 2.5 per cent of male and 1.4 per cent of female students aged 15–17 had misused tramadol in the past year. Students in that country also reported the use, to a lesser degree, of heroin or opium/morphine in 2016. Furthermore, data on the provision of treatment suggest that the prevalence of the non-medical use of opioids is quite high in Egypt. Tramadol tablets available in some parts of Africa are reportedly intended for the illicit market and may be of a dosage higher than usually prescribed for medical purposes.' UNODC reports that 'In North Africa, tramadol is reported as the main opioid used non-medically in Egypt, where scientific literature about tramadol misuse is more available than elsewhere in the subregion. An estimated 3 per cent of the adult population misused tramadol in 2016, the latest year for which data are available, while 2.2 per cent were diagnosed with tramadol dependence. In drug treatment, tramadol was also the main drug, accounting for 68 per cent of all people treated for drug use disorders in 2017. A cross-sectional study conducted over the period 2012–2013 among 1,135 undergraduate college students in Egypt showed that 20.2 per cent of male and 2.4 per cent of female students had misused tramadol at least once during their lifetime, resulting in an overall lifetime prevalence of 12.3 per cent The average age of initiation of non-medical use of tramadol was around 17 years. Polydrug use was also quite common, with the majority of respondents (85 per cent) reporting use of either tobacco, alcohol or cannabis with tramadol. Among those who had misused tramadol, 30 per cent were assessed to be tramadol dependent.' Pain management is what tramadol is meant to be useful for. UNODC says 'In West, Central and North Africa and the Middle East, tramadol – a pharmaceutical opioid not under international control – has emerged as a major opioid of concern. The drug, in addition to being diverted from the legal market, is mainly trafficked into those subregions in dosages higher than what is prescribed for pain management, with an increasing number of people with tramadol use disorder entering treatment.' The price of tramadol is what makes it the most suited opioid for poor nations. UNODC says that 'The drug use survey in Nigeria reveals tramadol to be a more accessible opioid than heroin, although it is still relatively costly if used frequently. While use of tramadol appears to cost about one third the price of heroin ($3.60 versus $10 per day of use in the past 30 days), in a country where the minimum wage of a full-time worker is around $57 per month, regular tramadol use still poses a considerable financial burden on users and their families. There is no information on the prevalence of drug use in other West African countries, but treatment data reveal tramadol to be the main drug of concern for people with drug use disorders. Tramadol ranks highly among the substances for which people were treated in West Africa in the period 2014–2017. This was particularly the case in Benin, Mali, the Niger, Nigeria, Sierra Leone and Togo.' It is especially among younger people in Africa that the use of tramadol is a serious concern. UNODC reports that 'The non-medical use of tramadol is of particular concern among young people in many countries in that subregion. For example, a cross-sectional study among 300 young people in western Ghana found that while the majority (85 per cent) of respondents knew someone who misused tramadol, more than half of the young people interviewed had used tramadol themselves for non-medical purposes, and one third of the users reported misusing 9–10 doses of tramadol per day. Another qualitative study from Ghana reported curiosity, peer pressure and iatrogenic addiction as the three main factors for initiation and continuing non-medical use of tramadol, while perceived euphoria, attentiveness, relief from pain, physical energy and aphrodisiac effects were mentioned as some of the reasons for continuing non-medical use of tramadol.' India, as the key source for tramadol, got away with it for some time. Its ruling dispensation peddled tramadol to whoever they could, including terrorist organizations who, in public it opposed, but in private worked hand in glove with. CSIS says that 'Indian tramadol networks have even been linked to ISIS and Boko Haram, raising security concerns. There have been several instances of seizures of tramadol from India destined for Islamic State territory. In May, $75 million worth of tramadol, about 37 million pills, was seized in Italy en route to Misrata and Tobruk, Libya; ISIS had purchased them for resale to ever-growing markets. The group has been involved in both the trafficking and consumption of tramadol, and the quantity of drugs being purchased by ISIS is so great that it can be assumed the group is selling a significant portion for profit. The 37 million tramadol tablets purchased by ISIS had taken a familiar route from India through Southeast Asia.' It is not just Africa that India peddles its tramadol to, it is also neighbouring countries in South East Asia. UNODC reports that 'The non-medical use of tramadol among other pharmaceutical drugs is reported by several countries in South Asia: Bhutan, India, Nepal and Sri Lanka. In 2017, 130,316 capsules containing tramadol and marketed under the trade name “Spasmo Proxyvon Plus (‘SP+’)” were seized in Bhutan. In Sri Lanka, about 0.2 per cent of the population aged 14 and older are estimated to have misused pharmaceutical drugs in the past year. Among them, the non-medical use of tramadol is the most common, although misuse of morphine, diazepam, flunitrazepam and pregabalin have also been reported in the country. The misuse of more than one pharmaceutical drug (including tramadol) is also a common pattern among heroin users who may use them to potentiate the effects of heroin or compensate for its low level of availability. Recent seizures of tramadol suggest the existence of a market for the drug: in April and September 2018, 200,000 and 1.5 million tablets of tramadol were respectively seized by customs in Sri Lanka.' When asked about its involvement in the tramadol crisis, the Indian government feigned ignorance. CSIS reports that 'One potential reason India does not regulate tramadol, or other opioids, is the lack of domestic concern about addiction. However, India does have addiction problems, and India’s Home Minister Shri Rajnath Singh specifically acknowledged that tramadol addiction is a growing problem. Yet, the government acknowledgement has not been sufficient; government corruption plays a role with the pharmaceutical corporations, wholesale exporters, and internet companies responsible for the illicit flow of opioids out of India. In their 2017 report on corruption, Transparency International found that India had the highest bribery rates across the Asia Pacific region.' Finally, with increasing international pressure, especially from African nations like Egypt, India put tramadol under the control of the NDPS Act in 2018. UNODC reports that 'The bulk of tramadol seized in the period 2014– 2018 was seized in West and Central Africa (notably in Nigeria, Benin, Côte d’Ivoire and the Niger), followed by North Africa (notably Egypt, Morocco and the Sudan) and the Near and Middle East (notably Jordan and the United Arab Emirates). In some instances, countries in Western and Central Europe (notably Malta and Greece) have been used as transit countries for tramadol destined for North Africa (Egypt and Libya), although some of the tramadol seized in Europe (in particular Sweden) was also intended for the local market. For the first time ever, significant seizures of tramadol were reported in South Asia (India) in 2018, accounting for 21 per cent of the global total that year, which reflects the fact tramadol was put under the control of the Narcotic Drugs and Psychotropic Substances Act of India in April 2018. As the full-scale scheduling of tramadol in India took place in 2018, and India had been the main source for (illegal) tramadol shipments, the decline in seizures outside India in 2018 may have been the result of a disrupted market. By contrast, and probably as a result of the control in India, seizures of tramadol in that country increased greatly in 2018, and thus in South Asia as a whole (more than 1,000-fold compared with a year earlier).'

While there is heroin for the super rich, codeine is there for the lowest rung of opium users. It is mass produced to cater to the needs of regions, and classes of users, that do not have access to the higher potency opium derivatives. You apparently cannot inject codeine, so it is mostly consumed in the form of cough syrups. William S Burroughs writes in Junk - 'I got a codeine script from an old doctor by putting down a story about migraine headaches. Codeine is better than nothing and five grains in the skin will keep you from being sick. For some reason, it is dangerous to shoot codeine in the vein.' NCBI reports that 'Codeine is the most commonly used opioid in the world. Regulation of its availability varies among countries; in New Zealand, the United Kingdom, most of Canada, and Ireland, codeine is available as an over-the-counter (OTC) preparation and is often combined with paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. Despite its wide use, there are a number of concerns about codeine as an analgesic, with risks of prolonged misuse of OTC codeine-ibuprofen products including life-threatening complications such as gastric bleeds, renal failure, hypokalemia, and opioid dependence. In addition to risk of serious harm, there is limited evidence for the addition of low-dose codeine (16 to 25 mg of codeine per dose) to paracetamol or ibuprofen preparations for improved pain relief. This, coupled with the known availability of effective nonopioid alternatives for pain relief, raises concerns about the place of low-dose codeine in ongoing pain management.' Besides being the world's leading manufacturer of legal heroin, the UK is also the world's leading manufacturer and exporter of codeine. INCB reports that 'The main countries manufacturing codeine were the United Kingdom (accounting for 68.3 tons, or 22.2 per cent of global manufacture), France (60.0 tons, or 19.5 per cent), Australia (40.7 tons, or 13.2 per cent), the Islamic Republic of Iran (22.2 tons, or 7.2 per cent) and the United States (21.9 tons, or 7.1 per cent)'. Regarding codeine exports, INCB writes that 'In 2018, world exports of codeine increased to 158.8 tons, compared with 139.2 tons in 2017, almost reaching the peak of 176.5 tons recorded in 2012 (see figure 16), and the United Kingdom became, for the first time, the main country exporting codeine (accounting for 35.2 tons, or 22.2 per cent of the global exports). It was followed by France (30.5 tons, or 19.2 per cent), Australia (29.5 tons, or 18.6 per cent), Norway (15.8 tons, or 9.9 per cent), the Islamic Republic of Iran (10.4 tons, or 6.6 per cent), Spain (6.6 tons, or 4.2 per cent), Italy (6.6 tons, or 4.1 per cent), Switzerland (5.9 tons, or 3.7 per cent), Slovakia (4.4 tons, or 2.8 per cent) and Hungary (3.9 tons, or 2.5 per cent).' India has developed the strategy of diluting the opium so that it can be sold to more people for larger margins, creating codeine-based cough syrups for both the local and international market, specifically Africa. INCB reports that 'According to the data reported for 2018, codeine was consumed mainly in India (46.1 tons, or 20.2 per cent of global consumption), the Islamic Republic of Iran (22.2 tons, or 9.8 per cent), France (20.6 tons, or 9.1 per cent), the United States (20.1 tons, or 8.8 per cent), Germany (15 tons, or 6.6 per cent), the United Kingdom (12.4 tons, or 5.5 per cent) and Canada (11.1 tons, or 4.9 per cent).' It is funny to see that despite being the world's largest producer of legal opium, India imports its codeine from countries like the UK, to which it sells the opium. This is surely because the pharmaceutical companies then dilute the opium to manufacture codeine and then export it back to India, where Indian pharmaceutical companies use it for cough syrups. Thus, both sides profit from this round tripping. INCB writes that 'The 10 main countries importing codeine in 2018 were India (35.9 tons), Germany (19.1 tons), Canada (11.7 tons), the United Kingdom (9.5 tons), Brazil (9.2 tons), Italy (8.8 tons), Hungary (7.0 tons), Viet Nam (6.7 tons), Switzerland (4.9 tons) and Oman (4.4 tons).' INCB reports that the world's largest manufacturer of codeine from poppy-straw was Australia in 2018. It reports that 'Australia accounted for 54.1 per cent of global production of poppy straw (Codeine), while Spain accounted for the remaining 45.9 per cent. Australia also accounted for most of its utilization (87.2 per cent); it was followed by Spain (12.8 per cent). Stocks of poppy straw (C) were held only by Spain (55.1 tons), France (35.3 tons) and Australia (9.6 tons).' Recently, Indian pharmaceutical companies were in the news for supplying codeine-based cough syrups that caused a number of deaths in African nations, causing widespread international attention, and creating pressure on the Indian government and regulatory bodies to bring in more stringent control over cough syrups manufactured in India.

Fentanyl represents an alarming twist to the opium problem in the world. In a very similar way to methamphetamine as a synthetic version of cocaine, fentanyl has emerged as a synthetic version of opium. Both these synthetic drugs do not need the natural plant as a raw material. Both synthetic drugs can be manufactured easily, anywhere, using easily available alternate precursors. Thus with fentanyl we see a similar escalation of the drug problem from having a natural foundation, which was itself difficult to regulate, to one having a synthetic foundation, making it impossible to contain. UNODC reports that 'The main concern for the authorities in a number of countries has been the emergence of new synthetic opioid receptor agonists (NPS with opioid effects), often fentanyl analogues, in recent years. Although fewer in number than other NPS categories, they have proved to be particularly potent and harmful, leading to increasing numbers of overdose deaths, in particular in North America and, to a lesser extent, in Europe and other regions.' Whereas earlier, only those who had access and could afford opium products used them, with fentanyls everybody has access. And as fentanyls flood the market based on a supply side boom, more and more individuals are falling victim to them. Quite often, fentanyls are sold as heroin, with many users unable to distinguish between the two. As Washington Post reports - 'Then fentanyl hit the streets. A synthetic opioid developed in 1960 by a Belgian physician, fentanyl is normally reserved for surgery and cancer patients. It is up to 100 times more powerful than morphine, its chemical cousin. For traffickers, illicit fentanyl produced in labs was the most lucrative opportunity yet, a chance to bypass the unpredictability of the poppy fields that produced their heroin. The traffickers could order one of the cheapest and most powerful opioids on the planet directly from Chinese labs over the Internet. It was 20 times more profitable than heroin by weight. By lacing a little of the white powdery drug into their heroin, the dealers could make their product more potent and more compelling to users. They called it China White, China Girl, Apache, Dance Fever, Goodfella, Murder 8 or Tango & Cash.' CSIS reports that 'Fentanyl exported from China to the United States comes in several different forms: fentanyl, its precursor chemicals, fentanyl variants, and fentanyl-laced counterfeit prescription opioids. India exports many controlled and prescription drugs to the United States, including fentanyl. Indian fentanyl exports to the United States are a fraction of those from China, but India does export tramadol, which is a growing issue for the United States. However, unlike China, which has now designated over 100 fentanyl variants and precursors on its list of controlled substances, India has not placed fentanyl, or most other opioids, on its controlled substances list, easing production and export. India only regulates 17 of the 24 basic precursor chemicals for fentanyl (as listed by the UN 1988 Convention against Drugs).' The New York Times reported that '“Fentanyl deaths are up, a 45 percent increase; that is not a success,” said Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco. “We have a heroin and synthetic opioid epidemic that is out of control and needs to be addressed.” Synthetic drugs tend to be more deadly than prescription pills and heroin for two main reasons. They are usually more potent, meaning small errors in measurement can lead to an overdose. The blends of synthetic drugs also tend to change frequently, making it easy for drug users to underestimate the strength of the drug they are injecting. In some parts of the country, drugs sold as heroin are exclusively fentanyls now.' Scientific American reports that 'Still, the number of drug overdose deaths continued to climb to a staggering 72,000 in 2017, with the sharpest increase among people who used fentanyl or other synthetic opioids. “All it takes is one exposure to fentanyl to die,” Kan said.' The European drug prevention agency, EMCDDA, reports that 'Illicitly manufactured fentanyl and its analogues are involved in large numbers of deaths in some countries, such as Estonia, and Sweden which saw a peak in 2017. In England, in the spring of 2017, intelligence from post-mortem results and drug seizures suggested that fentanyl and its analogues had been introduced into the heroin supply in the north of the country.' The mind-boggling varieties of fentanyl that is available, and constantly being created can be seen from NCBI's report - 'The open-web crawling/navigating software identified some 426 opioids, including 234 fentanyl analogs. Of these, 176 substances (162 were very potent fentanyls, including two ohmefentanyl and seven carfentanyl analogs) were not listed in either international or European NPS databases.' It is the wealthy nations of the world, with their addiction to opium, that are driving the fentanyl wave. The International Narcotics Control Board, INCB, reports that 'In 2018, most of the consumption of fentanyl (81.7 per cent) was concentrated in 10 countries, all of which were high-income countries. The three largest consumers of fentanyl were the United States (accounting for 20.8 per cent of global consumption, or 307.9 kg), Germany (17.6 per cent, or 259.4 kg) and the United Kingdom (15.6 per cent, or 230.6 kg). Other major consumers of fentanyl were, in descending order of the amounts consumed, Spain, Italy, France, the Netherlands, Canada, Australia and Belgium.' INCB reports that 'In 2018, fentanyl was mainly manufactured by the United States (740.7 kg, or 39.1 per cent of global manufacture), followed by Germany (548.3 kg, or 28.9 per cent), South Africa (238.4 kg, or 12.6 per cent), Belgium (229.8 kg, or 12.1 per cent) and the United Kingdom (94.7 kg, or 5.0 per cent). ' INCB further reports that 'Germany was also the principal importing country for fentanyl in 2018 (434.7 kg, or 35.5 per cent of global imports); it was followed by Spain (125.1 kg, or 10.2 per cent), the United Kingdom (111.2 kg, or 9.1 per cent), France (73.9 kg, or 6.0 per cent), Italy (54.6 kg, or 4.5 per cent) and the Netherlands (53.2 kg, or 4.3 per cent).' Regarding fentany exports, INCB reports that - 'The principal exporting countries [of fentanyl] were Germany (417.1 kg, or 44.6 per cent of global exports), Belgium (241.7 kg, or 25.9 per cent), the United States (90.7 kg, or 9.7 per cent) and the United Kingdom (64.3 kg, or 6.9 per cent).' UNODC reports that 'Overall, in 2018 overdose deaths attributed to synthetic opioids, comprising mainly fentanyls, accounted for nearly half of the total overdose deaths in the United States. Among the reasons for the high number of overdose deaths attributed to fentanyls are their often small lethal doses relative to other opioids: fentanyl, for example, is approximately 100 times more potent than morphine, and carfentanil may be as much as 10,000 times more potent than morphine for an average user. A lethal dose of carfentanil for a human can be as low as 20 micrograms. The rapid expansion of fentanyl use in the United States is also visible in the data on seizures and the drug samples analysed, with a considerable increase since 2014 in the number of samples identified as fentanyl. In 2018, fentanyl accounted for 45 per cent of the pharmaceutical opioids that were identified in different samples, while oxycodone accounted for 14 per cent.' UNODC reports that 'All factors driving fentanyl use converged from 2013 onwards in the United States and Canada, which may explain the unprecedented spread of the fentanyls in those markets: factors such as the diffusion of simpler, more effective methods of manufacture of synthetic opioids and their analogues (primarily fentanyls), assisted by the availability on the Internet of instructions for their manufacture; a shift from preparation by a limited number of skilled chemists to preparation by basic “cooks” who could simply follow the posted instructions; the discovery of ever more fentanyl analogues; a lack of effective control of precursors and oversight of the industry; expanding distribution networks that reduced the risk of detection through the use of postal services and the Internet; and increased licit trade including e-commerce.' Despite the ease of manufacturing fentanyl, it commands a price even greater than heroin. This is surprising. The only explanation I have is that the super rich are so stupid that they cannot make out the difference between heroin and fentanyl, and many times buy fentanyl thinking that it is heroin, or they have bought the sales talk of fentanyl peddlers. Maybe its the price quoted that makes them buy the fentanyl. If it is priced more, then it must be tried and bragged about, right? UNODC says 'There is a great incentive for trafficking organizations to expand the fentanyl market: the large associated revenues. Compared with heroin, the production costs of single-dose fentanyls are substantially lower. For instance, it may cost between $1,400 and $3,500 to synthesize 1 kg of fentanyl, which could bring a return of between $1 million and $1.5 million from street sales. For comparison, 1 kg of heroin purchased from Colombia may cost $5,000 to $7,000,99 around $53,000 at the wholesale level in the United States and around $400,000 at the retail level in the United States. With fentanyls, the logistics for supply are also more flexible because fentanyls can be manufactured anywhere and are not subject to the climatic conditions or the vulnerable conditions required for the largescale cultivation of opium poppy.' In this regard, UNODC reports that 'The current crisis of fentanyls appears to be more supply-driven than earlier waves of increases in the use of pharmaceutical opioids or heroin. Fentanyls are being used as an adulterant of heroin, are used to make falsified pharmaceutical opioids, such as falsified oxycodone and hydrocodone – and even falsified benzodiazepines – which are sold to a large and unsuspecting population of users of opioids and other drugs; users are not seeking fentanyl as such. It seems that some local distributors are not able to distinguish between heroin, fentanyl and fentanyl laced heroin, nor between diverted pharmaceutical opioids and falsified opioids containing fentanyl. A general problem with fentanyls is dosing by nonprofessional “pharmacists”, where small mistakes can lead to lethal results. Furthermore, as the overdose death data suggest, even people using cocaine and psychostimulants, such as methamphetamine, are also exposed – probably unintentionally – to fentanyls or other potent synthetic opioids mixed with those substances.' In another case of the US being flooded with Chinese products, it appears that fentanyl from China fooled the American rich. Getting a little wiser, the US decided to outsource manufacture to Mexico rather than have the Communists get them high. UNODC reports that 'According to United States authorities, most of the fentanyls destined for the North American market have been manufactured in China in recent years, from where they were either shipped directly to the United States, mostly through postal services, or were first shipped to Mexico and, to a lesser extent, Canada and then smuggled into the United States. However, after the introduction by China in May 2019 of drug controls based on generic legislation with regard to the fentanyls, which effectively brought more than 1,400 known fentanyl analogues under national control in China, early signs suggest that fewer fentanyls were smuggled from China to North America. At the same time, attempts to manufacture fentanyl and its analogues inside North America are increasing, notably in Mexico, by means of a method using precursor chemicals smuggled into the subregion from East Asia and South Asia.' India too appears to be playing a significant role in the outsourcing, revealing the workings of the key opponents to cannabis legalization. UNODC reports that 'The clandestine manufacture of fentanyls within North America is thus not really a new phenomenon and has the potential to increase in importance following the recent control of fentanyls substances in China. Moreover, the clandestine manufacture of fentanyl has already spread beyond North America to neighbouring subregions, as a clandestine fentanyl laboratory was dismantled in the city of Santiago, Dominican Republic, in 2017. At the same time, there is a risk that other countries with a large and thriving pharmaceutical sector may become involved in the clandestine manufacture of fentanyls. In 2018, for example, authorities of India reported two relatively large seizures of fentanyl destined for North America. Furthermore, according to United States authorities, in September 2018, the Directorate of Revenue Intelligence of India, in cooperation with DEA of the United States Department of Justice, dismantled the first known illicit fentanyl laboratory in India and seized approximately 11 kg of fentanyl'

Putting on a charade of containing opium

While on the one hand, the world's opium industry does all it can to sell as much product to as many users, law enforcement creates a mirage of trying to address the problem. In most places, the opium addict, once he has descended into the lower classes, is treated like an outcast. He is arrested for his opium dependence. William S Burroughs writes in Junk in 1952, 'In Louisiana a man could be arrested as a drug addict if he applied for the cure.' He further writes about the situation in the US in the 1950s, 'When I jumped bail and left the States, the heat on junk already looked like something new and special. Initial symptoms of nationwide hysteria were clear. Louisiana passed a law making it a crime to be a drug addict. Since no place or time is specified and the term "addict" is not clearly defined, no proof is necessary or even relevant under a law so formulated. No proof, and consequently, no trial. This is police-state legislation penalizing a state of being. Other states were emulating Louisiana. I saw my chance of escaping conviction dwindle daily as the anti-junk feeling mounted to a paranoid obsession, like anti-Semitism under the Nazis. So I decided to jump bail and live permanently outside the United States.'

Myths are created about the junk addict. For example, William S Burroughs writes in Junk - 'Officially sponsored myth 9 - '"There is a connection between junk and insanity. Addicts turn into maniacs when they cannot get junk." Actually, I have never seen or heard of an insane addict. For some reason, the two conditions do not occur together.' Another junk addict related myth that Burroughs writes about is 'Officially sponsored myth 5 - '"Addicts never get enough. They have to keep raising the dosage. They need more and more. Finally, I quote from a recent movie called Johnny Stool Pigeon - They tear the clothes off their skinny bodies and die screaming - for more junk." This is preposterous. Addicts get enough and they do not have to raise the dosage. I know addicts who have used the same dose for years. Of course, addicts do occasionally die if they are cut off the junk cold. They don't die because they need more and more. They die because they can't get any.' A third example of junk related myths that Burroughs writes about is 'Officially sponsored myth 4 - '"Addiction ruins the health and leads to early death." As I read in a magazine article; "Morphine addicts have numbered days on earth." Who hasn't? The addict enjoys normal health and lives as long, or longer, than the average. Junk conveys a considerable immunity to respiratory complaints. During the "flu" epidemic of 1918 junkies were found to be immune to flu and some addicts were let out of jail to help care for the sick. On the other hand, all users suffer somewhat from constipation and loss of appetite. Most of them lose weight, often running from ten to twenty pounds below normal during addiction.' Addiction to opium does not develop in a single instance of use, as the myth is sometimes propagated but comes from a prolonged daily usage for at least a month.' Burroughs further writes 'Officially sponsored myth 2 - '"A drug habit is formed instantly, on first use, or at most, after three or four shots." From this notion derive the stories of people becoming addicts after using a few "headache pills" given them by the Sympathetic Stranger. Actually, a non-user would have to take a shot every day for at least a month to get any kind of habit. The Stranger would go broke handing out samples. But a cured addict, even if he has not used it for years, can get a new habit in a few days.'

UNODC reports that 'Opioids (predominantly heroin) remain the main drug for which people undergo drug treatment in Europe (in particular Eastern and South-Eastern Europe) and Asia, accounting for nearly 50 per cent of all treatment admissions in 2018. Compared with users of other drugs, those with opioid use disorders entering treatment tend to be older, in their midthirties, and between one quarter and one third of them are first-time entrants. This corresponds to findings published in scientific literature, for instance studies from Europe, which suggest that there is an ageing cohort of opioid users in Europe.' UNODC says that 'There are also signs of increasing non-medical use of pharmaceutical opioids in Western and Central Europe, as reflected in the increasing proportion of treatment admissions for the use of those substances in recent years. In 2017, users of pharmaceutical opioids, including misused methadone, buprenorphine, fentanyl, codeine, morphine, tramadol and oxycodone, accounted for 22 per cent of all clients entering drug treatment in the subregion for opioid use disorders (as their primary drug).' As stated earlier, the cure for opium addiction is more opium, often of a lesser potency than the category the user is addicted to. This is called a reduction cure. Hence opium abuse treatment centers are well stocked with opioids to treat the user who comes in seeking help. The global opioid epidemic is so bad that there are scarcely enough treatment centers to meet the demand. In most poor countries, there are hardly any opioid abuse treatment centers. The US, which was already undergoing a major opioid crisis in the 1960s, faced problems of shortage of treatment centers decades ago. As William S Burroughs, writes in Junk, originally published in 1953 - 'Lexington and Forth Worth are the only two public institutions in the U.S. that give reduction cures. Both are usually full. According to bureaucratic regulations, anyone seeking admission to either hospital must send an application (in triplicate, of course) to Washington and wait several months to be admitted. Then he must stay at least six months. In Louisiana a man could be arrested as a drug addict if he applied for the cure.' Where there are treatment centers, only the rich can afford them. The system is set up in such a way that one is forced to go to a private opium de-addiction center which plays a crucial role in earning revenues for the opium industry. William S Burroughs writes in Junk - 'Federal and state narcotic authorities put every obstacle in the way of addicts who want a cure. No reduction cures are given in city or state institutions. Two hundred dollars is minimum for a ten-day cure in a private sanatorium. Hospitals are forbidden by law to give addicts any junk. I knew an addict who needed an operation for stomach cancer. The hospital could not give him any junk. Sudden withdrawal of junk plus the operation would likely have killed him so he decided to skip the operation.' The Hindu reports that in Pakistan 'Of the 6.7 million users, 4.25 million were drug dependent. Charas, a resin obtained from marijuana was used by four million people and heroin by 860,000. In addition injecting drug users numbered 430,000. A challenge for Pakistan is the very limited treatment centres, especially for women, he said. With a high number of drug dependents, treatment and specialist intervention was available to less than 30,000 users a year.' The Lancet reports that in Afghanistan 'In 2010, opioid use and dependence made the largest contribution to morbidity and mortality from illicit drug use, contributing to premature death from drug overdose and suicide, and in those who inject these drugs, infection with HIV and other blood-borne viruses. Dependence also produced considerable disability. Afghanistan has a tradition of opium smoking, and has long been a major source of illegal opiates for eastern and western Europe. In the past decade, Afghans have also reportedly begun to inject heroin and use pharmaceutical opioids. These developments have been attributed to increased heroin availability, civil disruption from insurgency, and the crowding of displaced Afghans into urban areas where heroin and pharmaceutical opioids are readily available.' The American Medical Journal reports that 'Between 2009 and 2010, 50% of patients admitted to hospitals for medical conditions received narcotics, and huge volumes of oxycodone and other opioids were produced, distributed, used, diverted, and abused. Opioid addiction and deaths, especially from heroin, continued to skyrocket.' Burroughs writes that 'The cure at Lexington is not designed to keep the addicts comfortable. It starts at one-quarter of a grain of M[orphine] three times a day and lasts eight days-the preparation now used is a synthetic morphine called dolophine. After eight days, you get a send-off shot and go over in "population." There you recieve barbiturates for three nights and that is the end of medication. For a man with a heavy habit, this is a very rough schedule. I was lucky, in that I came in sick, so the amount given in the cure was sufficient to fix me. The sicker you are and the longer you have been without junk, the smaller the amount necessary to fix you.' UNODC reports that 'Typically opioids like methadone and binuperphine are administered, in reduced doses, to opium addicts coming in for treatment. The amount of fentanyl available for medical consumption increased until 2010 but remained largely stable thereafter. By contrast, the amounts of buprenorphine and methadone available for medical consumption and used in the medically assisted treatment of opioid use disorders, have increased since 2014, especially of buprenorphine, which rose by more than 50 per cent over the period 2014–2018.10 However, as with other pharmaceutical opioids, there are large differences from one country to another in the consumption patterns of buprenorphine and methadone for medical purposes, as seen in the coverage of opioid-agonist treatment for people with opioid use disorders.' The treatment of opium addiction is a business in itself. The so-called treatment centers benefit vastly from the existence of a opium crisis in society. Health Affairs reports that 'Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.' This may be something that most people today are familiar with, having experienced the creation of a fake pandemic by the pharmaceutical and medical communities, in conjunction with governments and petrochemical companies. Hundreds of millions of persons worldwide gladly parted with their money for vaccines, all kinds of pharmaceutical drugs, hospitalization, masks, sanitizers, oxygen cylinders, tests, PPE kits and so on. The poor in the world were left with nothing, losing their jobs and many even their lives, not because of the fake pandemic, but because of the inhuman conditions created as a result of this massive hoax that was played on the world's entire population.

So the UK is the worlds leading manufacturer of legal heroin and codeine. It is the world's largest importer of legal codeine and morphine. It is the world's largest exporter of legal codeine and morphine. The US is the world's biggest heroin, morphine and fentanyl market. Both these countries are together the most responsible for the global ban on cannabis, and the creation of the subsequent global opium addiction and crisis. They actively oppose all efforts to legalize cannabis, given the high stakes that their governments have in the pharmaceutical and petrochemical industries. There is no shortage of lip service however. For example, the US White House says '“The sustained decrease in poppy cultivation and potential heroin production underlines the importance of maintaining strong United States-Mexico cooperation on drug policy,” said Acting Director of National Drug Control Policy Regina LaBelle. “The Biden-Harris Administration will build on this progress by investing historic amounts in public health strategies at home to reduce drug use and demand. Working with Mexico, we look forward to building on this success to address the production and trafficking of fentanyl, fentanyl analogues, and methamphetamine.”' The US White House further says that 'In recent years, we have seen synthetic opioids, such as illicitly manufactured fentanyl, drive many overdose deaths with cocaine- and methamphetamine-related deaths also increasing at alarming rates. The COVID-19 pandemic has exacerbated the overdose epidemic, as necessary pandemic restrictions made it harder for individuals with addiction to receive the treatment and support services they need. These factors contributed to the more than 93,000 drug overdose deaths in 2020. As a Nation, we need a strong response to America’s overdose epidemic and an investment in prevention, harm reduction, treatment and recovery services, as well as strategies to reduce the supply of illicit drugs.' All this is done while keeping cannabis illegal federally, even as 24 US states have legalized cannabis for recreational use and 38 US states have legalized cannabis for medical use. Over 70% of the US population think that cannabis must be legalized federally. But the federal government, be it Republican or Democratic, continues to dance to the tune of the pharmaceutical and petrochemical companies. There is also the baggage of guilt, I guess. Having bullied most nations in the world to ban cannabis, to now legalize it federally will be like having to eat one's words. The US federal government would rather not do that, preferring to send its people down the tunnel of despair that opium and methamphetamine has created, in addition to the existing legal drugs - alcohol and tobacco. The US DEA stated that '“The United States is facing an unprecedented crisis of overdose deaths fueled by illegally manufactured fentanyl and methamphetamine,” said Anne Milgram, Administrator of the Drug Enforcement Administration. “Counterfeit pills that contain these dangerous and extremely addictive drugs are more lethal and more accessible than ever before. In fact, DEA lab analyses reveal that two out of every five fake pills with fentanyl contain a potentially lethal dose...These counterfeit pills have been seized by DEA in every U.S. state in unprecedented quantities. More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined. DEA laboratory testing reveals a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a lethal dose. A deadly dose of fentanyl is small enough to fit on the tip of a pencil. Counterfeit pills are illegally manufactured by criminal drug networks and are made to look like real prescription opioid medications such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®). Fake prescription pills are widely accessible and often sold on social media and e-commerce platforms – making them available to anyone with a smartphone, including minors.' The US DEA is fully empowered to take cannabis out of the Controlled Substances Act, where it currently resides in the category of most dangerous drugs, Schedule I. Despite the overwhelming calls for legalization, and even the option of taking an intermediate step, that of moving cannabis from Schedule I to Schedule III as recommended by the HHS, the US DEA remains firmly deaf to everything that happens around it. Many in the US DEA are evangelists for cannabis prohibition, working zealously to project the myths about cannabis, since a large amount of DEA funding depends on the illegal status of cannabis. If cannabis is legalized, the US DEA, as with law and drug enforcement everywhere in the world, will have to start addressing the more dangerous and difficult to contain problems posed by fentanyls, methamphetamine, and other rapidly emerging synthetic drugs and novel psychotropic substances.

The opium experience

Speaking about the opium experience, William S Burroughs writes -'Opium is formed in the unripe seed pods of the poppy plant. Its function is to protect the seeds from drying out until the plant is ready to die and the seeds are mature. Junk continues to function in the human organism as it did in the seed pod of the poppy. It protects and cushions the body like a warm blanket while death grows to maturity inside. When a junkie is really loaded with junk he looks dead. Junk turns the user into a plant. Plants do not feel pain since pain has no function in a stationary organism. Junk is a pain killer. A plant has no libido in the human or animal sense. Junk replaces the sex drive. Seeding is the sex of the plant and the function of opium is to delay seeding. Perhaps the intense discomfort of withdrawal is the transition from plant back to animal, from a painless, sexless, timeless state back to sex and pain and time, from death back to life.' Burroughs writes 'Junk is a biological necessity when you have a habit, an invisible mouth. When you take a shot of junk you are satisfied, just like you ate a big meal. You don't want another shot right away.' Regarding morphine, Burroughs writes that 'Morphine hits the backs of the legs first, the the back of the neck, a spreading wave of relaxation slackening the muscles away from the bones so that you seem to float without outlines, like lying in warm salt water. As this relaxing wave spread through my tissues, I experienced a strong feeling of fear. I had the feeling that some horrible image was just beyond the field of vision, moving, as I turned my head, so that I quite never saw it. I felt nauseous. I lay down and closed my eyes. A series of pictures passed, like watching a movie. A huge, neon-lighted cocktail bar that got larger and larger until streets, traffic, and street repairs were included in it; a waitress carrying a skull on a tray; stars in a clear sky. The physical impact of the fear of death; the shutting off of breath; the stopping of blood.'

Speaking about the development of the opium habit, Burroughs writes that 'As a habit takes hold, other interests lose importance to the user. Life telescopes down to junk, one fix and looking forward to the next, "stashes" and "scripts," "spikes" and "droppers." The addict himself often feels that he is leading a normal life and that junk is incidental. He does not realize that he is just going through the motions in his non-junk activities. It is not until his supply is cut off that he realizes what junk means to him.' On this subject, he further writes that 'The actual changes are difficult to specify and they do not show up in the mirror. That is, the addict himself has a special blind spot so far as the progress of the habit is concerned. He generally does not realize that he is getting a habit at all. He says there is no need to get a habit if you are careful and observe a few rules, like shooting every other day. Actually, he does not observe these rules, but every extra shot is regarded as exceptional. I have talked to many addicts and they all say they were surprised when they discovered they actually had the first habit. Many of them attributed their symptoms to some other cause.' He says 'I also stopped bathing. When you use junk the feel of water on the skin is unpleasant for some reason, and junkies are reluctant to take a bath.' On the subject, Burroughs further says that 'You don't wake up one morning and decide to become a drug addict. It takes at least three months' shooting twice a day to get any habit at all. And you don't really know what junk sickness is until you have had several habits. It took me almost six months to get my first habit, and then the withdrawal symptoms were mild. I think it is no exaggeration to say it takes about a year and several hundred injections to make an addict'

Speaking about junk sickness, Burroughs writes 'When you are junk sick you dream about junk. A curious fact about junk dreams is that something always happens to prevent you from getting a shot. The cops rush in, the needle stops up, the dropper breaks. Anyway, you never get it. I have talked to other users, and I have never known anyone who ever got fixed in a dream.' Addressing the nature of junk sickness, Burroughs writes 'It would seem that junk is the only habit-forming drug. Cats cannot be addicted to morphine, as they react to an injection of morphine with acute delirium. Cats have a relatively small quantity of histamine in the blood stream. It would seem that histamine is the defense against morphine, and that cats, lacking this defense, cannot tolerate morphine. Perhaps the mechanism of withdrawal is this: Histamine is produced by the body as a defense against morphine during the period of addiction. When the drug is withdrawn, the body continues to produce histamine.' Further he writes - 'Withdrawal symptoms are allergic symptoms: sneezing, coughing, running at the eyes and nose, vomiting, diarrhea, hive-like conditions of the skin. Severe withdrawal symptoms are shock symptoms: lowered blood pressure, loss of body fluid and shrinking of the organism as in the death process, weakness, involuntary orgasms, death through collapse of the circulatory system. If an addict dies from junk withdrawal, he dies of allergic shock.' Further talking about opium sickness Burroughs says 'There was a raw ache in my lungs. People vary in the way junk sickness affects them. Some suffer mostly from vomitting and diarrhea. The asthmatic type, with narrow and deep chest, is liable to violent fits of sneezing, watering at eyes and nose, in some cases spasms of the bronchial tubes that shut off the breathing. In my case, the worst thing is lowering of blood pressure with consequent loss of body fluid, and extreme weakness, as in shock. It is a feeling as if the life energy has been shut off so that all the cells in the body are suffocating. As I lay there on the bench, I felt like as if I was subsiding into a pile of bones.' Does this ring a bell regarding the symptoms of the so-called pandemic Covid? Burroughs says that junk sickness from eating opium is far worse than junk sickness from injecting it. He writes that 'When you kick the spike you get worse until you hit the third day and you think, this is it: You couldn't feel worse. But the fourth day is worse. After the fourth day relief is dramatic. And on the sixth day there is only a pale shadow of junk sickness. But with an eating habit you can look forward to at least ten days of horrible suffering. So when you are taking a cure with hop you have to be careful not to get an eating habit. If you can't make it on schedule, best go back to the needle.' Further talking about the eating habit, he says 'An eating habit is the worst habit you can contract. It takes longer to break than a needle habit, and the withdrawal symptoms are considerably more severe. In fact, it is not uncommon for a junkie with an eating habit to die if he is cut off cold turkey in jail. A junkie with an eating habit suffers from excruciating stomach cramps when he is cut off. And the symptoms last up to three weeks as compared to eight days on a needle habit.' When we consider that most persons who take prescription opioids, legally or illegally, are developing eating habits, then we can understand why so many get addicted to it. Burroughs writes 'Junk is a cellular equation that teaches the user facts of general validity. I have learned a great deal from using junk: I have seen life measured out in eyedroppers of morphine solution. I experienced the agonizing deprivation of junk sickness, and the pleasure of relief when junk-thirsty cells drank from the needle. Perhaps all pleasure is relief. I have learned the cellular stoicism that junk teaches the user. I have seen a cell full of sick junkies silent and immobile in separate misery. They knew the pointlessness of complaining or moving. They knew that basically no one can help anyone else. There is no key, no secret someone else has that he can give you.'

Speaking about the post junk addiction experience, Burroughs writes - ''When you give up junk, you give up a way of life. I have seen junkies kick and hit the lush and wind up dead in a few years. Suicide is frequent among ex-junkies. Why does a junkie quit junk of his own will? You never know the answer to that question. No conscious tabulation of the disadvantages and horrors of junk gives you the emotional drive to kick. The decision to quit junk is a cellular decision, and once you have decided to quit you cannot go back to junk permanently any more than you could stay away from it before. Like a man who has been away a long time, you see things different when you return from junk.'

Speaking about the difficulty in ceasing the opium habit, Burroughs writes 'I knew that I did not want to go on taking junk. If I could have made a single decision, I would have decided no more junk ever. But when it came to the process of quitting, I did not have the drive. It gave me a terrible feeling of helplessness to watch myself break every schedule I set up as though I did not have control over my actions.' Burroughs writes in the Prologue of his book Junk 'I have learned the junk equation. Junk is not, like alcohol or weed, a means to increased enjoyment of life. Junk is not a kick. It is a way of life.' Burroughs writes that 'An addict may be ten years off the junk, but he can get a new habit in less than a week; whereas someone who has never been addicted would have to take two shots per day for two months to get any habit at all. I took a shot daily for four months before I could notice withdrawal symptoms. You can list the symptoms of junk sickness, but the feel of it is like no other feeling and you can not put it into words. I did not experience this junk sick feeling until my second habit.'

Other associated harms of opium usage besides addiction and overdose deaths

One of the problems of using a needle to inject opium is the other health risks that rise with needle sharing, especially HIV and Hepatitis C. UNODC reports that 'The greatest harms to health are those associated with the use of opioids and with injecting drug use, owing to the risk of acquiring HIV or hepatitis C through unsafe injecting practices.' UNODC says that 'The prevalence of PWID [persons who inject drugs] aged 15–64 in 2018 continues to be the highest in Eastern Europe (1.26 per cent) and Central Asia and Transcaucasia (0.63 per cent). Those percentages are, respectively, 5.5 and 2.8 times higher than the global average. More than a quarter of all PWID reside in East and South-East Asia, although the prevalence itself is relatively low (0.19 per cent). The three subregions with the largest numbers of PWID (East and South-East Asia, North America and Eastern Europe) together account for over half (58 per cent) of the global number of PWID. It is noteworthy that, as in previous years, while three countries – China, the Russian Federation and the United States – account for just 27 per cent of the global population aged 15–64, they are home to almost half (43 per cent) of all PWID.' Because of the stigma associated with injecting drugs, most numbers are underestimates, as reported by the UNODC which says 'Owing to the criminalization of drug use, punitive laws, stigma and discrimination against people who use or inject drugs in many parts of the world, conventional survey methods have been found to underestimate the actual population size because of the hidden nature of PWID [persons who inject drugs]; therefore, only indirect methods have been shown to reflect the situation of PWID with greater accuracy. Overall, new or updated estimates of PWID were available for 40 countries in 2018.' UNODC says that 'Injecting drug use is a significant public health concern and causes morbidity and mortality owing to the risk of overdose and blood-borne infections (mainly HIV and hepatitis B and C), transmitted through the sharing of contaminated needles and syringes and other drug paraphernalia or risky sexual behaviour in some groups and subsequent severe immunosuppression, cirrhosis, neoplastic disease and inflammation sequelae. Social and physical effects can further aggravate potential underlying mental health conditions.' UNODC, in its World Drug Report 2020, says regarding hepatitis C that 'PWID [persons who inject drugs] are a key population affected by hepatitis C. Global estimates suggest that 71 million people worldwide were chronically infected with hepatitis C in 2017 and that 23 per cent of new hepatitis C infections and one in three hepatitis C-related deaths are attributable to injecting drug use. Hepatitis C-related morbidity and mortality continue to rise, mainly as a result of cirrhosis, hepatocellular carcinoma and death in cases of untreated hepatitis C'. It further says that 'UNODC, WHO, UNAIDS and the World Bank jointly estimated the prevalence of hepatitis C among PWID [persons who inject drugs] worldwide in 2018 to be 48.5 per cent, or 5.5 million (range: 4 million to 7.8 million) people aged 15–64. This estimate is based on estimates in 108 countries, covering 94 per cent of the estimated global number of PWID.' It adds that 'Although data coverage was low in the Caribbean, the highest prevalence of hepatitis C among PWID [persons who inject drugs] was found in that subregion, at 76 per cent, followed by East and South-East Asia, Western and Central Europe, North America, and Central Asia and Transcaucasia, where it ranged between 61 and 54 per cent. In North Africa, a hepatitis C prevalence of 25 per cent was found among PWID, compared with a combined prevalence in the general population (>15 years) in North Africa and the Middle East estimated at 3.1 per cent. In Central Asia, a hepatitis C prevalence of 54 per cent was found among PWID, compared with a range of 0.5 to 13.1 per cent among the general population'. Speaking of the problems of HIV among needle users, UNODC says that 'The largest number of PWID [persons who inject drugs] living with HIV reside in Eastern Europe, East and South-East Asia and South-West Asia, which together account for 67 per cent of the global total. Although the prevalence of HIV among PWID (9.3 per cent) is below the global average, a fifth of the global number of PWID living with HIV reside in East and South-East Asia. A small number of countries continue to account for a large proportion of the total global number of PWID living with HIV. In 2018, for example, PWID living with HIV in China, Pakistan and the Russian Federation accounted for almost half of the global total (49 per cent), while PWID in those three countries comprise only a third of all PWID worldwide.' UNODC says that 'Injecting drug use is estimated to account for approximately 10 per cent of HIV infections worldwide and 30 per cent of all HIV cases outside Africa, while in the eastern countries of the WHO European Region more than 80 per cent of all HIV infections occur among PWID [persons who inject drugs]. PWID are estimated to be 22 times more likely than people in the general population to be living with HIV.'

This association of opium with alcohol is something that, I think, has not been explored much. William S Burroughs says that they generally do not go together, unlike cannabis and alcohol. He says that when one is on opium, one does not generally drink. According to him 'As I began using stuff every day, or often several times a day, I stopped drinking and going out at night. When you use junk you don't drink. Seemingly, the body that has a quantity of junk in its cells will not absorb alcohol. The liquor stays in the stomach, slowly building up nausea, discomfort, and dizziness, and there is no kick. Using junk would be a sure cure for alcoholics.' So, if the alcohol industry is really keen on upping its sales, it should work for the legalization of cannabis which will bring down the demand for opium, and increase the demand for alcohol along with cannabis. On the other hand, it appears that once an opium addict is through with the habit, he or she has a tendency to get deeply addicted to alcohol instead. Many of these persons end up dead within a very short time, according to him, because of the extent of alcohol consumption that happens subsequently. Speaking about the subsequent addiction to alcohol post coming out of an opium habit, Burroughs writes - 'Ike came back from the bathroom with the works and began cooking up a shot. He kept talking. "You're drinking and you're getting crazy. I hate to see you get off this stuff and on something worse. I know so many that quit the junk. A lot of them can't make it with Lupita. Fifteen pesos for a paper and it takes three to fix you. Right away they start in drinking and they don't last more than two or three years."' He further writes 'Ike took a very severe view of my drinking. "You're drinking, Bill. You're drinking and getting crazy. You look terrible. You look terrible in your face. Better you should go back to stuff than drink like this." It is worth researching the number of persons, formerly opium addicts, who then went on to die of alcohol. I suspect that there may be a significant number of such cases that are finally attributed to alcohol, but opium also played a role in it.

The causes behind the opium crisis

The escalation of the opium crisis has many factors. These factors show a similarity with the rise of the stimulant crisis involving cocaine and methamphetamine. It even shows similarities with how alcohol and tobacco emerged to become the problems that they are today. In all these situations we can see the following sequence of events:

Discovery by the elites and ruling classes of a potent natural plant used traditionally by indigenous communities for thousands of years for recreation, medicine and spirituality;
An overwhelming desire among the ruling elites to consume, possess and profit from the natural plant;
Regulation and control of the natural plant so that it is taken out of the hands of the indigenous communities and placed fully in control of the elites;
Ramping up of the potency of the natural plant through synthesis so that the final product bears little resemblance to the natural plant;
Ramping up of the price of the synthesized product so that it can be sold at high prices that make it accessible and affordable only to the rich elite classes;
Distributing the product through legal and illegal channels - such as pharmaceutical companies and the black market - so that it is available to the elite classes all over the world;
Amassing vast amounts of wealth through the process of control, increased potency, high prices, and global distribution of the drug among the elites;
Creation of synthetic versions of the drug in the laboratory that do not even need the natural plant as a raw material, thus eliminating a key bottleneck arising from the scarce availability of the natural plant;
Spawning of multiple manufacturing centers across the world that create the mimicked product and flood the market, making it almost impossible to detect the difference between the synthetic product and the plant based product;
Widespread proliferation of the synthetic products that can no longer be detected or controlled by regulatory or drug enforcement agencies;
Increased use of newer synthetic chemical precursors to manufacture the product, even as regulatory bodies attempt to ban known precursors;
Dropping prices of the synthetic products making them available to all sections of society, unlike the initial natural based product that was only available to those who could afford and access them i.e. the elites;
Widespread damage to public health through the combined effect of both the plant based as well as the synthetic precursor based product.

UNODC reports that 'From what is known, it is possible to identify common threats and different dynamics in the two opioid crises, in Africa and in North America: • The ease of manufacturing, easy accessibility and low-cost production make the illicit markets for tramadol and fentanyls substantially more profitable for traffickers than are other opioids such as heroin. • The large-scale manufacture of tramadol and fentanyls for the illicit market started in a context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. • The interchangeability (or substitution) of fentanyl and tramadol within the pharmaceutical and illicit drug markets makes it more difficult to address their misuse. Their non-medical use is also seen in the context of self-medication, and thus carries less stigma or is countered by lesser legal sanctions than is the case with other controlled drugs.' UNODC says 'Although geographically disconnected, the areas that were initially affected by the opioid crisis in Canada and the United States have experienced remarkably similar market dynamics, which can be broadly described in the following sequential steps: (a) High rates of prescriptions for pharmaceutical opioids leading to diversion and an increase in the non-medical use of pharmaceutical opioids, opioid use disorders and an increase in opioid overdose deaths (b) Regulations introduced to reduce diversion and non-medical use of pharmaceutical opioids (e.g., tamper-proof formulations to prevent injecting) (d) Fentanyl (illicitly manufactured in clandestine laboratories) and its analogues emerge as adulterants in heroin and stimulants (cocaine and methamphetamine) and are sold as falsified pharmaceutical opioids, resulting in massive increases in deaths attributed to fentanyls (e) Fentanyls emerge as the dominant opioid in opioid overdose deaths, as well as contributing to overdose deaths attributed to other drugs (g) Fentanyl-related deaths are the main contributor to total opioid overdose deaths;' UNODC further says that 'The scientific literature has attempted to understand the reasons for the sudden rise of fentanyls in preexisting opioid markets. It seems that an interplay between a number of external factors and local market dynamics played a role in the spread of the opioid crisis in North America. Some of the factors that have led to the rise and continued presence of fentanyls include: (a) the diffusion of simpler and more effective methods of manufacture of synthetic opioids and their analogues (primarily fentanyls); (b) a lack of effective control of precursors and oversight of the manufacture industry; (c) expanding distribution networks; (d) reduced smuggling risks because of new methods of trafficking within the expanded licit trade; and (e) pre-existing market conditions (demand for opioids and potential supply shocks)' UNODC reports that 'Ease of manufacturing and low production costs helped to seed both crises, as did the context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. Both crises were inflamed by the availability of the substances on pharmaceutical and illicit markets – making it more difficult to detect and prevent their misuse.' Even though the drugs of concern appear different in different parts of the world, the process is the same, and this applies as much to stimulants like cocaine and methamphetamine as it does to opium and fentanyl. UNODC says that 'In West, Central and North Africa, the opioid crisis is fuelled by tramadol; in North America, by fentanyls. Although those subregions have little in common in terms of economics, demographics or general patterns of drug use, both are struggling with an opioid crisis fuelled by substances that are easy to access and cheap to produce.'

One of the biggest reasons why the world has not been able to come to terms with its opium problem is that the danger of opium is, incredibly, still very poorly understood. Most harm reduction efforts continue to lump all drugs together in one basket called 'Drugs', failing to differentiate between the threats, especially to life, posed by each category of drugs. There is also the strong conditioning in society that anything that the physician prescribes, or the pharmaceutical company sells, must be good for us.

The term addiction is also tossed around loosely. Almost every habit developed involving illegal drugs is termed addiction, whereas it should be only the life threatening habits that must be termed addiction. In this proper classification of what constitutes addiction, there will be many traditional categories that will fall out, and many categories added that will make the rich and powerful uncomfortable. For example, most users of prescription medication of all classes - including blood pressure, diabetes, pain, depression, anxiety and sleep will fall into the category of addicts, as their stoppage of daily prescription medication could become life threatening, since their bodies, having developed dependency on these prescription drugs, no longer produce the necessary mechanisms to regulate health. It is this improper classification of who is an addict and who is not, and the clumping together of various drugs under a single 'Drugs' heading, and the exclusion of key categories of addictive drugs that prevents the addressal of opium addiction. William S Burroughs, writes in Junk, originally published in 1953 that 'Officially sponsored myth 1 -'"All drugs are more or less similar and all are habit forming." This myth lumps cocaine, marijuana and junk together. Marijuana is not at all habit forming and its action is almost the direct opposite from junk action. There is no habit to cocaine. You can develop a tremendous craving for cocaine, but you won't be sick if you can't get it. When you have a junk habit, on the other hand, you live in a state of chronic poisoning for which junk itself is the specific antidote. If you don't get the antidote at eight-hour intervals, and enough of it, you develop symptoms of allergic poisoning: yawning, sneezing, watering of the eyes and nose, cramps, vomiting and diarrhea, hot and cold flushes, loss of appetite, insomnia, restlessness and weakness, in some cases circulatory collapse and death from allergic shock....When I say "habit-forming drug" I mean a drug that alters the endocrinal balance of the body in such a way that the body requires that drug in order to function. So far as I know, junk is the only habit forming drug according to this definition.'

The categorization of cannabis as a most harmful drug, placed in Schedule 1 of the US Controlled Subtances Act, while prescription opioids are freely available is an example of the problem. UNODC reports that 'An estimated 192 million people used cannabis in 2018, making it the most used drug globally. In comparison, 58 million people used opioids in 2018. But that lower number of users belies the harm associated with opioids. This group of substances accounted for 66 per cent of the estimated 167,000 deaths related to drug use disorders in 2017 and 50 per cent of the 42 millions years (or 21 million years) lost due to disability or early death, attributed to drug use.' The difference between cannabis and opium, in terms of harmfulness, can be judged from this. But most people will consider prescription opioids as medicine and cannabis as a 'drug'.

How can we tackle the opium crisis?

The answer to the opium crisis - in fact to all the drug crisis in the world today, including cocaine, methamphetamine, alcohol, tobacco, and a whole range of prescription pharmaceutical drugs and novel psychotropic substances - is one and the same. It is the legalization once again of the natural plants that were taken out of the hands of the indigenous communities and placed in the hands of the elites leading to the increased potency and pricing of the compounds contained in the plants, increased demand and scarcity, and the subsequent evolution of synthetic versions of the compounds which meant that the problem was now completely out of control. All this came with great wealth for the elites but the costs to society and planet are far greater. Only when all the natural plants - opium, coca, cannabis, etc., - are completely legalized so that they can be cultivated once again by the indigenous communities as before can balance be restored. The re-introduction into society of the natural versions of cocaine, methamphetamine, opioids and fentanyls will bring down the scale of harm that the synthesized drugs are causing.

Coca and opium can only be cultivated in limited regions across the world. Therefore, their ability to meet the needs of the global population are not sufficient. In addition to this, coca and opium have associated harms that are deleterious to human health.

There is only one plant that can completely negate the harms of opioids, cocaine, methamphetamine, fentanyls, novel psychotropic substances, alcohol and tobacco. That is cannabis. Cannabis can grow everwhere in the world, making it accessible and affordable to the entire world's population. Even today, despite the global prohibition on cannabis, there are officially 250+ million cannabis users world wide, as compared to the tens of millions of opioid, cocaine and methamphetamine users. All the users, official and unofficial, of the non-cannabis drugs combined will not equal the number of global users of cannabis. And all this with cannabis being illegal world wide. One key factor to consider is that the majority of the users of the non-cannabis drugs are from the upper classes or from the upper middle classes. Most users of cannabis are from the poorer classes world wide. Cannabis cannot be suppressed, no matter what efforts the rich put in. In the process of trying to suppress cannabis and become rich, the rich will only kill themselves. Many users of non-cannabis drugs say that they do so because they have no other options. If cannabis was freely available, they would gladly choose it. William S Burroughs writes in Junk that 'When you're sick, music is a great help. Once, in Texas, I kicked a habit on weed, a pint of paregoric and a few Louis Armstrong records.' He further writes that 'I once kicked a junk habit with weed. The second day off junk I sat down and ate a full meal. Ordinarily, I can't eat for eight days after kicking a habit.' Nepali Times reports that 'Activists also say that marijuana can help control crime and wean the dependency on other hard drugs. The most vivid proof of that is KC, who did heroin for 22 years. He says marijuana coul be added to harm reduction in drug rehab in Nepal if it was available legally. “Take it from me, marijuana was my saviour. It made my pain bearable and took away my addiction to heroin. Believe me, many heroin addicts like me would give up heroin,” says KC.'
With complete global legalization of cannabis, a significant proportion of the users of other drugs will shift to cannabis. Cannabis will provide the much needed relief for the majority of the world - its billions of people with no access to, or means of affording, any of the above listed drugs. As Harm Reduction Journal reports 'Cannabis alone will not end opioid use disorder and associated morbidities and mortality. However, the introduction of ever more powerful opioids like fentanyl and carfentanyl into the illicit drug market and the resulting day-to-day increase in opioid overdoses highlights the immediate need for innovative short and long term intervention strategies to add to current efforts like ORT, heroin maintenance programs, supervised consumption sites, the depenalization of substance use, and increased education and outreach on the potential harms associated with both prescription and illicit opioid use. The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to seek the immediate implementation of cannabis-based interventions in the opioid crisis at the regional and national level, and to subsequently assess their potential impacts on public health and safety.' NORML reports that 'Prior clinical trials have reported that CBD administration is associated with reduced cravings for both heroin and tobacco. A literature review published in the journal Substance Abuse: Research and Treatment previously concluded, “CBD seems to have direct effects on addictive behaviors.”'

Numerous studies have recently highlighted the ability of cannabis to reduce opium dependence, especially in US states and Canada where cannabis has been legalized for adult recreational use. Science Direct reports that 'Highlights - delta9-tetrahydrocannabinol (THC) enhances the antinociceptive effects of oxycodone; Vaporized and injected THC reduces oxycodone self-administration; Cannabinoids may reduce opioid use for analgesia; Cannabinoids may reduce nonmedical opioid use.' Marijuana Moment reports that 'Looking at mortality records from 2009 to 2015, a team of researchers investigated whether the presence of dispensaries in counties with medical cannabis laws had an effect on deaths from prescription opioids, synthetic opioids and heroin. The results supported previous research, indicating that access to marijuana can mitigate the opioid epidemic. But not all counties in legal states allow dispensaries to operate. The study found that counties with dispensaries experience six to eight percent fewer opioid overdose deaths overall and 10 percent fewer heroin overdose deaths.' Marijuana Moment further reports that 'Seventy-two percent of individuals [in the US study] who reported substitution said they had completely ceased opioid use, 68 percent said they stopped taking benzodiazepines and 80 percent got off SSRI anti-depression medication. About 70 percent [in the Canadian study] said they used marijuana as a substitute for prescription drugs—35 percent for opioids, 11 percent for anti-depressants, eight percent for anti-seizure medications, four percent for sleeping pills and muscle relaxants and four percent for benzodiazepines.' NORML reports that 'Patients who were taking opioids prior to their enrollment in the study reduced their daily drug intake over the trial period – a finding that is consistent with those of other longitudinal studies...Investigators observed initial reductions in patients’ opioid consumption at three months. Patients further reduced their opioid intake at six months and again at twelve months. Authors concluded, “Taken together, the results of this study add to the cumulative evidence in support of plant-based MC (medical cannabis) as a safe and effective treatment option and potential opioid substitute or augmentation therapy for the management of chronic pain symptomatology and quality of life.”' Oxford University Press reports that 'Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.' Science Direct reports that 'A meta-analysis of pre-clinical studies indicated in 2017 that the median effective dose (ED50) of morphine administered in combination with delta-9-tetrahydrocannabinol (delta-9-THC) is 3.6 times lower than the ED50 of morphine alone (Nielsen et al., 2017).' PolitiFact reports that 'The analysis looked at nine separate studies involving a total of 7,222 participants across the U.S., Canada and Australia that "found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by (medical cannabis) users, compared to people with no additional use of" medical cannabis. Those studies confirm Larson’s assertion: There was a 64% to 75% reduction in opioid dosage when patients supplemented their chronic pain treatments with medical cannabis, and 32% to 59% of cannabis users reported a complete end to opioid use.' NORML reports 'Investigators with the University of Victoria in Vancouver assessed prescription drug use patterns over a six-month period in a cohort of 1,145 authorized medical cannabis patients. Researchers reported that 28 percent of subjects acknowledged using opioid medications at the initiation of the trial. This fell to 11 percent six months later. Participants’ mean opioid dosage fell by 78 percent over the trial period – a finding consistent with prior studies.' Springer Publications reports that 'The proportion of individuals who reported using opioids decreased by half, from 40.8% at baseline to 23.9% at 12 months.' Marijuana Moment reports that '“Our findings suggest that increasing availability of legal cannabis (modeled through the presence of medical and recreational dispensary operations) is associated with a decrease in deaths associated with the T40.4 class of opioids, which include the highly potent synthetic opioid fentanyl,” it continues. “This finding is especially important because fentanyl related deaths have become the most common opioid related cause of death.”' Springer Publications reports that 'Over the 42-month period, the mean MED [morphine equivalent dose]/claim declined within public plans (p < 0.001). However, the decline in MED/claim was 5.4 times greater in the period following legalization (22.3 mg/claim post vs. 4.1 mg/claim pre). Total monthly opioid spending was also reduced to a greater extent post legalization ($Can267,000 vs. $Can95,000 per month). The findings were similar for private drug plans; however, the absolute drop in opioid use was more pronounced (76.9 vs. 30.8 mg/claim).' NORML reports that 'investigators “found that increased medical and recreational storefront dispensary counts are associated with reduced opioid related mortality rates during the study period. These associations appear particularly strong for deaths related to synthetic opioids such as fentanyl. Given the alarming rise in the fentanyl-based market in the US, and the increase in deaths involving fentanyl and its analogs in recent years, the question of how legal cannabis availability relates to opioid related deaths is particularly pressing. Overall, our study contributes to understanding the supply side of related drug markets and how it shapes opioid use and misuse.”' Wiley Publications reports that 'We used a differences-in-differences (DD) approach and found that the implementation of medical marijuana laws (MMLs) and recreational marijuana laws (RMLs) reduced morphine milligram equivalents per enrollee by 7% and 13%, respectively. The reduction associated with MMLs was predominately in people aged 55–64, whereas the reduction associated with RMLs was largely in people aged 35–44 and aged 45–54. Our findings suggest that both MMLs and RMLs have the potential to reduce opioid prescribing in the privately insured population, especially for the middle-aged population.' NORML reports that 'Researchers reported: “We found that amongst cannabis users, those who use cannabis daily are less likely to have opioid use than people who use cannabis occasionally. This association was present for both men and women.” NORML further reports that 'Twenty percent of subjects who consumed cannabis products reported experiencing “complete” relief from their pain. Thirty-nine percent of participants said that they helped “a lot.” NORML says 'Most subjects reported that their use of CBD-dominant products led them to reduce their use of prescription pain medicines, specifically opioids – a finding that is consistent with other studies.' NORML says in another report that 'Authors concluded: “Our results support prior studies suggesting cannabis may improve pain and minimize opioid utilization in both cancer and non-cancer settings. … Incorporating cannabis into routine cancer care may improve pain control and minimize opioid requirements.”' NORML reports that 'A team of Israeli investigators affiliated with Tel Aviv University assessed the relationship between cannabis and opioids in a cohort of patients with non-cancer specific chronic pain. All of the patients enrolled in the study were prescribed medical cannabis therapy in accordance with Israel’s medical cannabis access laws. Among those patients who reported using opioids at baseline, 93 percent either “decreased or stopped [using] opioids following cannabis initiation” – a finding that is consistent with dozens of other studies.'

Opium works on the mu and sigma receptors of the brain, whereas cannabis works primarily on cannabinoid receptors that were only discovered as recently as the 1990s. The prohibition of cannabis has very severly constrained research into cannabis. Episteme Health reports that 'The mechanisms by which cannabinoids reduce opioid addiction-relevant behaviours include modulation of cannabinoid, serotonin, and dopamine receptors, as well as signalling cascades involving ERK-CREB-BDNF and peroxisome proliferator-activated receptor-a. Identifying the receptors involved and their mechanism of action remains a critical area of future research.'

In many US states where cannabis has been legalized for medical and/or adult recreational use, opioid addiction is one of the qualifying conditions for medical cannabis usage. The legalization of cannabis for medical and/or recreational use has had significant positive effects in many US states. Marijuana Moment reports that 'As with past studies examining correlations between medical marijuana and opioid prescriptions, the Columbia analysis found a marked drop in prescriptions among states with medical cannabis laws (MCLs). “State MCLs were associated with a statistically significant reduction in aggregate opioid prescribing of 144,000 daily doses (19.7% reduction) annually,” the study, published this month in the Journal of the American Academy of Orthopaedic Surgeons, says. Medical cannabis laws “were associated with a statistically significant reduction of 72,000 daily doses of hydrocodone annually.”' NCBI reports that 'Researchers concluded: "In this study, we observed dynamic changes in opioid distribution for eleven opioids used for pain and OUD [opioid use disorder] within Colorado, and two carefully selected comparison states, Utah and Maryland, from 2007 to 2017. Colorado, after legalizing recreational marijuana, had a significant decrease in prescription opioids distributed for pain. The findings from this geographically limited study were challenging to interpret because, while analgesic opioid use was unchanged in Utah, Maryland also had a significant decline [though this decline was not as significant as was observed in Colorado.] Other national research more clearly showed that marijuana policies were associated with reductions in analgesic opioid use. This appears to be an empirically informed public policy strategy which may contribute to reversing the US opioid epidemic."' Liebert Publications reports that 'Our findings demonstrate that THC produced robust antinociception equivalent to the whole extract in models of thermal and inflammatory nociception. Thus, other cannabinoid constituents including terpenes do not add to the analgesic actions of cannabis beyond that of isolated THC. This analgesia across several pain models suggest a range of clinical applications for THC'

In most places in the US, where medical cannabis is legal, it is the patient that asks the physician to recommend cannabis, or the patient self-treating with cannabis. NCBI reports that 'Overall, these PROs underscore four key points: 1) individuals are substituting cannabis for prescription drugs, independent of whether they identify themselves as medical users (medical users are doing so at almost five times the odds of non-medical users) and independent of legal access to medical cannabis; 2) this practice increases in frequency with age, up to 65 years, and is more common in females, particularly female medical users, and Native American/Asians/Pacific Islanders; 3) the most common classes of substitution were narcotics/opioids, anxiolytics/benzodiazepines and antidepressants; and 4) the odds of reporting substituting cannabis for prescription drugs were more than one and a half times greater among those reporting the use of cannabis to manage pain, anxiety and depression than among those using it to manage only one of these three conditions. Stated differently, pain, anxiety and depression seem to represent a comorbidity triad that is associated with greater substitution frequency.' NORML reports that 'The percentage of chronic pain patients using cannabis therapeutically is increasing, according to data published in the journal Advances in Therapy. Investigators affiliated with Harvard Medical School assessed trends in cannabis use among pain patients in a nationally representative sample during the years 2011 to 2015. Authors reported, “Over the course of our study, … we identified a significant and progressive increase in the number of patients using cannabis. In patients with chronic pain, cannabis use more than doubled during this period.” They reported that the average age of chronic pain patients who consumed cannabis was 45 and that the majority of users were lower on the socioeconomic scale than were non-users.' Liebert Publications reports that 'Conclusions: In this long-term observational study, cannabis use worked as an alternative to prescription opioids in just over half of patients with low back pain and as an adjunct to diminish use in some chronic opioid users.'

Slowly, the US medical community is also starting to acknowledge that cannabis can help reduce opioid dependence, and treat most conditions that opium is used for. NORML reports that 'Nearly three in four licensed health care professionals in Washington state endorse the use of medical cannabis as a substitute for opioids in patients with chronic pain, according to survey data published in the journal Cannabis and Cannabinoid Research.' In December 2023, the US HHS recommended to the US DEA the rescheduling of cannabis from the current Schedule I in the Controlled Substances Act to the less restrictive Schedule III. In December 2020, the UN rescheduled cannabis from its most restrictive Schedule IV to Schedule I based on recommendations by WHO. But despite all these changes, the global opium cartel ensures that on the ground there is no change in terms of cannabis access for the vast majority of the world that needs it. The vast majority of the medical community still works with the synthetic pharmaceutical industry, stating that cannabis is a dangerous drug that must remain prohibited. The opium plant is not as regulated as the cannabis plant. Surprisingly (or maybe as expected) it is only heroin, derived from the opium plant, that is placed in the US DEA schedule 1 list of banned substances and the UN list of schedule 4 substances, not the entire opium plant, unlike the case of cannabis, where, ridiculously, the whole plant is a schedule 1 substance in the US and the UN.

Many opponents of cannabis try to argue that legalizing cannabis will result in widespread cannabis addiction. It is a widely proven fact that cannabis is not addictive. Yes, when it is freely available a small percentage of users may overindulge in it. This is not because of its addictive nature, but an inherent trait of the individual who is prone to overindulge in anything that he or she likes, be it cannabis, junk food, smartphones or sex. It is far safer to overindulge in cannabis than it is to overindulge in junk food, alcohol, opioids, or even smartphones for that matter. When cannabis was completely legal in India, until the end of the 19th century, the Indian Hemp Drugs Commission of 1894-95 found that only about 5% of overall users could be termed as excessive users, and many of these excessive users were religious mendicants who lived in harsh conditions over extended periods of time. The vast majority of cannabis users, the 95%, were moderate consumers who used their cannabis judiciously and responsibly. The Indian Hemp Drugs Commission corroborates what William S Burroughs says regarding opium addicts who have been put in prison. Whereas cannabis users show no sign of discomfort when their access to cannabis is cut off, the opium users suffer greatly. The Commission stated that 'The pretty general belief is that the habit is not easily broken off when once formed; but the difficulty is not believed to be so great as in the case of either alcohol or opium. It is apparently greater than in the case of tobacco. The experience of our jails seems clearly to confirm the general opinion that the opium habit takes a much stronger hold than the ganja habit, and that no injurious physical effects follow the compulsory cessation of the latter.'

The nature of treatment for cannabis over use is an indicator of the threat posed by it. Over use of opium or alcohol can result in death, and the treatment for these conditions involves gradually reducing the dosage of the drug until the user reaches a stable state. Sudden cessation of these drugs of dependence is likely to kill the addict. Cannabis abuse related treatment involves the same kind of methods as that for smartphone addiction or sex addiction, involving behavioral changes to get out of a non-life threatening bad habit. UNODC reports that 'The increase in treatment demand related to cannabis use disorders in some regions warrants special attention. There is great variability in the definition and practice of what constitutes treatment of cannabis use disorders. Treatment at present consists of behavioural or psychosocial interventions, such as cognitive behavioural therapy (in which irrational, negative thinking styles are challenged and the development of alternative coping skills is promoted) and motivational interviewing (in which a user’s personal motivation to change their own behaviour is facilitated and engaged). These interventions may vary from one-time online contact or screening and brief intervention in an outpatient setting, to a more comprehensive treatment plan including treatment of other comorbidities in an outpatient or inpatient setting. Some of the factors that may influence the number of people in treatment for cannabis use disorders include changes in the number of people who actually need treatment; changes in the treatment referral system; changes in awareness of potential problems associated with cannabis use disorders; and changes in the availability of and access to treatment for cannabis use disorders.' As William S Burroughs said, cannabis is not addictive. An addiction means the development of biological dependency on an external substance, due to which the body stops functioning as it normally would. Sudden cessation of this external dependency could prove fatal. That is what addiction is, and that is how opium is addictive, alcohol is addictive, and most prescription synthetic pharmaceutical medications that hundreds of millions of individuals take daily, as recommended by their doctors and pharmaceutical companies, is addictive. The propaganda around cannabis, however, continues to state that cannabis is addictive, while masking the truly addictive, government endorsed substances like pharmaceutical opioids, alcohol, tobacco, and a whole range of prescription medications. For example, William S Burroughs writes in Junk that 'In 1937, weed was placed under the Harrison Narcotics Act. Narcotics authorities claim it is a habit-forming drug, that its use is injurious to mind and body, and that it causes the people who use it to commit crimes. Here are the facts: Weed is positively not habit forming. You can smoke weed for years and you will experience no discomfort if your supply is cut off. I have seen tea heads in jail and none of them showed withdrawal symptoms. I have smoked weed myself off and on for fifteen years, and never missed it when I ran out. There is less habit to weed than there is to tobacco. Weed does not harm the general health. In fact. most users claim it gives you an appetite and acts as a tonic to the system. I do not know of any other agent that gives as definite a boot to the appetite. I can smoke a stick of tea and enjoy a glass of California sherry and a hash house meal.'

In Summary

It is an undeniable fact that pain exists in every part of the world. It is physical and mental, short term and chronic. The pain felt by the majority of the world - its poor, its working and laboring classes, its indigenous communities, its sick, its elderly - have all fallen on deaf ears for too long now, as the global elites continue to pursue their wealth, having cruelly taken away even the few things that nature had created for the benefit of all - human and non-human. The pain is only going to increase as the gap between the rich and the poor widens, as resources become scare for an over-populated human world, as humans increasingly lose their connection with nature, as nature starts to hit back for the pain we have caused her through our damage to the planet.

It is also an undeniable fact that humans need stimulants, intoxicants, anodynes, sedatives, and so on. This has always been the case, right from the beginning. To experience the joys of life, and not just its pain, we need all of this. And cannabis is one plant that can significantly increase the joy of life and reduce its pain.

Opium is only medicine for pain. Cannabis is a highly versatile medicine for a whole range of medical conditions that afflict humans and other animals. The prohibition of cannabis led to the rise of opium. Now opium, with its derivatives and synthetic analogues, is a global problem for those who have access to it. For those who used cannabis, their medicine was taken away. Cannabis must be restored to treat the world's opium addiction.

If home growing of cannabis and recreational use of it is legalized worldwide, the losses to the opioid and opium industries will be significant. It will mean a need to almost reinvent the core competencies of many of these industries, as well as the potential loss of billions of dollars in research costs, that will go down the drain. As the fake global pandemic Covid that has left the world reeling has shown, the resistance to worldwide cannabis legalization is going to be stiff from these and related entities because some entities only look at the balance sheet and not the global balance in terms of human health and nature. Countries like China, India, the US, the UK, Russia, whose blind rush to global economic dominance is fueled significantly by the opioid and pharma industry, and whose leaders have an unquenchable thirst for power and influence, may not stop at anything to achieve their goals.

The following list of articles taken from various media speak about the above subject. Words in italics are the thoughts of yours truly at the time of reading the article.

'Researchers with the University of Buffalo School of Pharmacy assessed the use of cannabis products in a cohort of 69 PD patients. All of the study’s participants possessed an authorization from their doctor to access state-licensed medical cannabis products. Most subjects consumed cannabis in the form of a tincture containing a 1 to 1 ratio of THC and CBD.

Investigators reported: “Eight-seven percent of patients exhibit[ed] an improvement in PD symptoms after starting MC [medical cannabis]. Symptoms with the highest incidence of improvement included cramping/dystonia, pain, spasticity, lack of appetite, dyskinesia [involuntary movements], and tremor. After starting MC, 56 percent of opioid users were able to decrease or discontinue opioid use with an average daily morphine milligram equivalent change from 31 at baseline to 22 at the last follow-up visit. MC was well-tolerated with no severe AEs [adverse events] reported and low rate of MC discontinuation due to AEs.”

Nearly 25 percent of US patients with Parkinson’s disease report being active cannabis consumers, according to survey data compiled by the Parkinson’s Foundation. Separate survey data compiled last year by researchers with the University of Colorado reports that PD patients who use either CBD or whole-plant cannabis products frequently acknowledge improvements in their sleep, pain, anxiety, and agitation.'

https://norml.org/news/2023/04/20/study-patients-with-parkinsons-disease-report-symptom-relief-use-fewer-opioids-following-cannabis-treatment/

'The objective of the curfew is to discourage any VC sappers or other bomb-throwing terrorist types who might otherwise feel free to skulk around at night and cause trouble. But one of the most painfully visible side effects of the curfew has been to make us all prisoners from nine in the night until six in the morning in whatever hotel we're staying in: and after a month or so of this, a lot of people are starting to cave in to almost any vice or noxious habit that they can get their hands on. The styles of overindulgence seem to vary - from one hotel to another. The Continental, for instance, is considered to be full of "pinkos and dope fiends" by the "old Asia hands" across the square in the Caravelle, where the political style is more hawkish and the vice style tends more to booze and brawling.

Last night in the Caravelle bar, an argument between some British correspondents and a group of pilots from the Flying Tiger airlines erupted into violence and serious beating for one of the Britishers...while the only casualties in the Continental last night occurred in a room just up the wide spiral staircase from mine, where a half-dozen American journalists were brought to their knees by a combination of opium, Pernod, and brutal Cambodian grass.

These are some of the people I would have to wake up and depend on for guidance in the wake of a sudden rocket attack. This afternoon I tried to teach some of them to use the hellishly expensive but technically simple Transciever radio units I brought back from Hong Kong - along with about a thousand hits of Lomotil and three quarts of a powerful antinausea medicine called Emetrol - but not even the sharpest of the Time and Newsweek correspondents could cope with a basic walkie-talkie set.'

- Interdicted Dispatch from the Global Affairs Desk, May 22, 1975, Fear and Loathing at the Rolling Stone, The Essential Writing of Hunter S. Thompson

'“[T]he ability of WPE [whole-plant cannabis extract] to reduce opioid reward and drug seeking behavior appears quite robust and of great clinical utility,” authors concluded. “Additional systematic research is required to fully evaluate the potential for CBD to serve as an adjunct treatment for opioid use disorder.”

A limited number of clinical trials have previously demonstrated the ability of CBD to mitigate subjects’ cravings for various substances, including heroin, tobacco, and cannabis. Other studies indicate that CBD may also play a role in mitigating symptoms of opioid withdrawal. According to a 2020 review paper, “[E]vidence … demonstrates the potential [of] cannabis to ease opioid withdrawal symptoms, reduce opioid consumption, ameliorate opioid cravings, prevent opioid relapse, improve OUD treatment retention, and reduce overdose deaths.”'

https://norml.org/news/2023/03/23/cbd-administration-mitigates-opioid-cravings-in-animals/

'The question is frequently asked: Why does a man become a drug addict?

The answer is that he usually does not intend to become an addict. You don't wake up one morning and decide to become a drug addict. It takes at least three months' shooting twice a day to get any habit at all. And you don't really know what junk sickness is until you have had several habits. It took me almost six months to get my first habit, and then the withdrawal symptoms were mild. I think it is no exaggeration to say it takes about a year and several hundred injections to make an addict' - Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'The question, of course, could be asked: Why did you ever try narcotics? Why did you continue using it long enough to become an addict? You become a narcotics addict because you do not have strong motivations in any other direction. Junk wins by default. I tried it as a matter of curiosity. I drifted along taking shots when I could score. I ended up hooked. Most addicts I have talked to report a similar experience. They did not start using drugs for any reason they can remember. They just drifted along until they got hooked. If you have never been addicted, you can have no clear idea what it means to need junk with the addict's special need. You don't decide to be an addict. One morning you wake up sick and you're an addict.'

- Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'Results: CBD has been reported to have several therapeutic properties including anxiolytic, antidepressant, anti-inflammatory, anti-emetic, analgesic, as well as reduction of cue-induced craving for opioids, all of which are highly relevant to opioid withdrawal syndrome. In addition, CBD has been shown in several clinical trials to be a well-tolerated with no significant adverse effects, even when co-administered with a potent opioid agonist.

Conclusions: Growing evidence suggests that CBD could potentially be added to the standard opioid detoxification regimen to mitigate acute or protracted opioid withdrawal-related symptoms. However, most existing findings are either based on preclinical studies and/or small clinical trials. Well-designed, prospective, randomized-controlled studies evaluating the effect of CBD on managing opioid withdrawal symptoms are warranted.'

https://www.liebertpub.com/doi/full/10.1089/can.2021.0089

'The drug haul is considered to be one of the biggest in the world with the value of the seized heroin estimated to be Rs 21,000 crore in the international markets. One kg of the drug sells at Rs 5 to 7 crore. "A total of eight persons including four ...'

https://www.deccanherald.com/national/west/ed-to-launch-probe-into-mundra-heroin-haul-under-pmla-1033395.html

'“The United States is facing an unprecedented crisis of overdose deaths fueled by illegally manufactured fentanyl and methamphetamine,” said Anne Milgram, Administrator of the Drug Enforcement Administration. “Counterfeit pills that contain these dangerous and extremely addictive drugs are more lethal and more accessible than ever before. In fact, DEA lab analyses reveal that two out of every five fake pills with fentanyl contain a potentially lethal dose. DEA is focusing resources on taking down the violent drug traffickers causing the greatest harm and posing the greatest threat to the safety and health of Americans. Today, we are alerting the public to this danger so that people have the information they need to protect themselves and their children.”

These counterfeit pills have been seized by DEA in every U.S. state in unprecedented quantities. More than 9.5 million counterfeit pills were seized so far this year, which is more than the last two years combined. DEA laboratory testing reveals a dramatic rise in the number of counterfeit pills containing at least two milligrams of fentanyl, which is considered a lethal dose. A deadly dose of fentanyl is small enough to fit on the tip of a pencil.

Counterfeit pills are illegally manufactured by criminal drug networks and are made to look like real prescription opioid medications such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®); or stimulants like amphetamines (Adderall®). Fake prescription pills are widely accessible and often sold on social media and e-commerce platforms – making them available to anyone with a smartphone, including minors.'

https://www.dea.gov/press-releases/2021/09/27/dea-issues-public-safety-alert-sharp-increase-fake-prescription-pills

'The United States is committed to working together with the countries of the Western Hemisphere as neighbors and partners to meet our shared challenges of drug trafficking and use. My Administration will seek to expand cooperation with key partners, such as Mexico and Colombia, to shape a collective and comprehensive response and expand efforts to address the production and trafficking of dangerous synthetic drugs that are responsible for many of our overdose deaths, particularly fentanyl, fentanyl analogues, and methamphetamine. In Mexico, we must continue to work together to intensify efforts to dismantle transnational criminal organizations and their networks, increase prosecutions of criminal leaders and facilitators, and strengthen efforts to seize illicit assets. In Bolivia, I encourage the government to take additional steps to safeguard the country’s licit coca markets from criminal exploitation and reduce illicit coca cultivation that continues to exceed legal limits under Bolivia’s domestic laws for medicinal and traditional use. In addition, the United States will look to expand cooperation with China, India, and other chemical source countries in order to disrupt the global flow of synthetic drugs and their precursor chemicals. '

https://www.whitehouse.gov/briefing-room/presidential-actions/2021/09/15/a-memorandum-for-the-secretary-of-state-on-presidential-determination-on-major-drug-transit-or-major-illicit-drug-producing-countries-for-fiscal-year-2022/

'I have never regretted my experience with drugs. I think I am at better health now as a result of using junk at intervals than I would be if I had never been an addict. When you stop growing you start dying. An addict never stops growing. Most users periodically kick the habit, which involves shrinking of the organism and replacement of the junk-dependent cells. A user is in continual state of shrinking and growing in his daily cycle of shot-need for shot completed.'

- Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'Health Canada data says more than 21,000 Canadians have died from opioid-related overdoses since 2016. Since the onset of the COVID-19 pandemic, fatalities have reached record-high levels, with about 17 people dying per day last year.

All parties have promised support for measures ranging from harm reduction, including supervised consumption sites, to recovery.'

https://www.cbc.ca/news/canada/calgary/federal-election-opioid-drugs-crisis-1.6171434

'Today, Regina LaBelle, Acting Director of National Drug Control Policy, presented to Congress the Biden-Harris Administration’s recommendations for a long-term, consensus approach to reduce the supply and availability of illicitly manufactured fentanyl-related substances (FRS), while protecting civil rights and reducing barriers to scientific research for all Schedule I substances. The proposal, developed by the Office of National Drug Control Policy (ONDCP), the Department of Health and Human Services (HHS), and the Department of Justice (DOJ), is part of the Administration’s larger effort to address addiction and the overdose epidemic at a critical time when overdose deaths have reached a record high.'

https://www.whitehouse.gov/ondcp/briefing-room/2021/09/02/biden-harris-administration-provides-recommendations-to-congress-on-reducing-illicit-fentanyl-related-substances/

https://www.wsj.com/articles/taliban-afghanistan-heroin-ban-opium-production-11630181316

'In recent years, we have seen synthetic opioids, such as illicitly manufactured fentanyl, drive many overdose deaths with cocaine- and methamphetamine-related deaths also increasing at alarming rates. The COVID-19 pandemic has exacerbated the overdose epidemic, as necessary pandemic restrictions made it harder for individuals with addiction to receive the treatment and support services they need. These factors contributed to the more than 93,000 drug overdose deaths in 2020. As a Nation, we need a strong response to America’s overdose epidemic and an investment in prevention, harm reduction, treatment and recovery services, as well as strategies to reduce the supply of illicit drugs. '

https://www.whitehouse.gov/briefing-room/presidential-actions/2021/08/27/a-proclamation-on-overdose-awareness-week-2021/

'Junk is a cellular equation that teaches the user facts of general validity. I have learned a great deal from using junk: I have seen life measured out in eyedroppers of morphine solution. I experienced the agonizing deprivation of junk sickness, and the pleasure of relief when junk-thirsty cells drank from the needle. Perhaps all pleasure is relief. I have learned the cellular stoicism that junk teaches the user. I have seen a cell full of sick junkies silent and immobile in separate misery. They knew the pointlessness of complaining or moving. They knew that basically no one can help anyone else. There is no key, no secret someone else has that he can give you.'

- Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'The overwhelming majority of pain patients provided medical cannabis treatment report either reducing or ceasing their use of opioid medications, according to data published in the Journal of Addictive Diseases.

A team of Israeli investigators affiliated with Tel Aviv University assessed the relationship between cannabis and opioids in a cohort of patients with non-cancer specific chronic pain. All of the patients enrolled in the study were prescribed medical cannabis therapy in accordance with Israel’s medical cannabis access laws.

Among those patients who reported using opioids at baseline, 93 percent either “decreased or stopped [using] opioids following cannabis initiation” – a finding that is consistent with dozens of other studies.'

https://norml.org/news/2021/08/05/survey-over-90-percent-of-chronic-pain-patients-report-mitigating-their-use-of-opioids

'“I think it’s 100 percent necessary that we actually have an understanding of the consequences of legalizing marijuana are going to have into the children and adolescent brain and what are the consequences,” Volkow replied. “We owe it to the public to actually provide that information.”'

https://www.marijuanamoment.net/senators-and-federal-officials-discuss-marijuana-legalization-and-drug-harm-reduction-at-overdose-hearing/

'Last week, we got some terrible news: In 2020, the number of drug overdose deaths in the US reached their highest point ever recorded — more than 93,000, according to preliminary federal data.

And then this week, we got some more terrible news: Life expectancy in the US fell by 1.5 years — the worst decline since World War II. Most of that was due to Covid-19. But some of it was driven by the increase in overdoses.'

https://www.vox.com/22589160/opioid-epidemic-drug-overdose-deaths-2020-life-expectancy

'The estimated 93,331 deaths from drug overdoses last year, a record high, represent the sharpest annual increase in at least three decades, and compare with an estimated toll of 72,151 deaths in 2019, according to provisional overdose-drug data released Wednesday by the Centers for Disease Control and Prevention....

An estimated 57,550 people died of overdoses from synthetic opioids, primarily fentanyl, an increase of more than 54% over 2019, according to Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. “Definitely fentanyl is the driving factor,” he said. Overdose deaths from opioids overall rose nearly 37%, according to the CDC data.

Deaths from overdoses of methamphetamine and cocaine also rose, the CDC said.'

https://www.wsj.com/articles/u-s-drug-overdose-deaths-soared-nearly-30-in-2020-11626271200

'I have learned the junk equation. Junk is not, like alcohol or weed, a means to increased enjoyment of life. Junk is not a kick. It is a way of life.'

- Prologue, Junky, William S Burroughs, 1977, originally published in 1953

'It appears that cannabidiol and cannabinoid receptor 1 (CB1R) antagonists have potential for treating drug-craving and drug-seeking behaviour, based on evidence from preclinical animal models. Ligands which inhibit the action of cannabinoid degradation enzymes also show promise in reducing opioid withdrawal symptoms and opioid self-administration in rodents. Agonists of CB1R could be useful for treating symptoms of opioid withdrawal; however, the clinical utility of these drugs is limited by side effects, the potential for cannabinoid addiction and an increase in opiate tolerance induced by cannabinoid consumption. The mechanisms by which cannabinoids reduce opioid addiction-relevant behaviours include modulation of cannabinoid, serotonin, and dopamine receptors, as well as signalling cascades involving ERK-CREB-BDNF and peroxisome proliferator-activated receptor-a. Identifying the receptors involved and their mechanism of action remains a critical area of future research.'

https://epistemehealth.com/index.php/nab/article/view/14

'Researchers reported: “Medical cannabis use led to improvements in achieving personalized pain goals and lower overall opioid requirements. No serious adverse events with cannabis were reported, and most patients who used cannabis reported that benefits outweighed negative effects.”

Authors concluded: “Our results support prior studies suggesting cannabis may improve pain and minimize opioid utilization in both cancer and non-cancer settings. … Incorporating cannabis into routine cancer care may improve pain control and minimize opioid requirements.”'

https://norml.org/news/2021/06/17/clinical-trial-cancer-patients-reduce-their-intake-of-opioids-following-medical-cannabis-treatment

'“The sustained decrease in poppy cultivation and potential heroin production underlines the importance of maintaining strong United States-Mexico cooperation on drug policy,” said Acting Director of National Drug Control Policy Regina LaBelle. “The Biden-Harris Administration will build on this progress by investing historic amounts in public health strategies at home to reduce drug use and demand. Working with Mexico, we look forward to building on this success to address the production and trafficking of fentanyl, fentanyl analogues, and methamphetamine.”'

https://www.whitehouse.gov/ondcp/briefing-room/2021/06/10/the-office-of-national-drug-control-policy-announces-the-third-consecutive-year-of-reduction-in-poppy-cultivation-and-potential-heroin-production-in-mexico/

'Morphine hits the backs of the legs first, the the back of the neck, a spreading wave of relaxation slackening the muscles away from the bones so that you seem to float without outlines, like lying in warm salt water. As this relaxing wave spread through my tissues, I experienced a strong feeling of fear. I had the feeling that some horrible image was just beyond the field of vision, moving, as I turned my head, so that I quite never saw it. I felt nauseous. I lay down and closed my eyes. A series of pictures passed, like watching a movie. A huge, neon-lighted cocktail bar that got larger and larger until streets, traffic, and street repairs were included in it; a waitress carrying a skull on a tray; stars in a clear sky. The physical impact of the fear of death; the shutting off of breath; the stopping of blood.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Researchers with the University of California and the University of Washington surveyed 253 participants from seven pain management clinics in southern California. Participants in the study suffered from back pain, nerve pain, migraine, fibromyalgia, and other pain conditions.

Sixty-two percent of participants reported using CBD products, with over one-half of participants (91 percent) acknowledging that these products also contained THC. Subjects were most likely to inhale/smoke cannabis products, although just over half of respondents also reported using edibles and tinctures.

Twenty percent of subjects who consumed cannabis products reported experiencing “complete” relief from their pain. Thirty-nine percent of participants said that they helped “a lot.” Most subjects reported that their use of CBD-dominant products led them to reduce their use of prescription pain medicines, specifically opioids – a finding that is consistent with other studies.'

https://norml.org/news/2021/05/20/survey-pain-patients-consuming-cbd-dominant-products-report-reduced-opioid-use

'Findings: Following principles of harm reduction and risk minimization, we suggest cannabis be introduced in appropriately selected CNCP [Chronic non-cancer pain] patients, using a stepwise pproach, with the intent of pain management optimization. We use a structured approach to focus on low dose cannabis (namely, THC) initiation, slow titration, dose optimization and frequent monitoring.

Conclusion: When low dose THC is introduced as an adjunctive therapy, we observe better pain control clinically with lower doses of opioids, improved pain related outcomes and reduced opioid related harm.'

https://www.frontiersin.org/articles/10.3389/fphar.2021.633168/full

'Authors concluded: “This short-term analysis on this population-based study of patients in Alberta, Canada showed that authorization for medical cannabis had intermediate effects on weekly OME in adults prescribed chronic opioids treatment, which was dependent on initial opioid dose. …

Greater observations of changes in OME [oral morphine equivalent] appear to be in those patients who were on a high dosage of opioids (OME > 100). … Overall, our findings may contribute ongoing evidence for clinicians regarding the potential impact of medical cannabis to reduce the opioid burden among patients.”'

https://norml.org/news/2021/05/13/study-medical-cannabis-authorizations-correlated-with-reduced-use-of-opioids

The global opioid crisis, deep rooted and increasingly pervasive, hides behind the mask of the coronavirus...legalize the ganja globally to counter the underlying disease of opioid addiction and its fatalities..

Updated May 06, 2021 2:02:37pm

'He located a doctor in Brooklyn who was a writing fool. That croaker would go three scripts a day for as high as thirty tablets a script. Every now and then he would get dubious on the deal, but the sight of money always straightened him out.'

- Junky, William S Burroughs, 1977, originally published in 1953

NSAIDs for inflammation such as aspirin, ibuprofen, naproxen increase risk of a range of gastrointestinal (GI) problems, kidney disease and adverse cardiovascular events. Large doses of NSAIDs significantly suppress the production of immune cells. By inhibiting physiological COX activity, all NSAIDs increase the risk of kidney disease and through a related mechanism, heart attack.

Higher doses of analgesics like paracetamol may lead to toxicity, including liver failure. Paracetamol poisoning is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia, and New Zealand. There is a consistent association of increased mortality as well as cardiovascular (stroke, myocardial infarction), gastrointestinal (ulcers, bleeding) and renal adverse effects with taking higher dose. Acetaminophen(paracetamol) treats pain mainly by blocking COX-2 and inhibiting endocannabinoid reuptake almost exclusively within the brain, but not much in the rest of the body.

Besides this, prolonged use of all opioids and NSAIDs cause multi-organ failure.

May 05, 2021 2:49:53pm

There is a new disease afflicting the insane in this country. Its called the Oxygen Shortage Disease. Since the insane are incapable of reasoning, they fail to see that this also is a result of excess and improper administering of synthetic pharmaceutical drugs to vulnerable individuals. So move over Covid, its time for the manufacturers of oxygen (no, not nature) to join the medical industry and pharma companies in milking the cattle...

Respiratory depression is the most serious adverse reaction associated with opioid use. Some opioids show toxicity with single use while others display toxicity build up over a period of time with chronic use.

The following are some opioids that cause respiratory depression - heroin, morphine, codeine, fentanyl, methadone, hydrocodone, hydromorphone, oxycodone, buprenorphine.

Besides this, prolonged use of all opioids and NSAIDs cause multi-organ failure.

May 05, 2021 2:48:21pm

Has the Mexican government met the April 30 deadline, extended twice already, set by the Mexican Supreme Court for recreational cannabis legalization? The government has been requesting extensions citing Covid and issues with the bill's content. Mexico supplies heroin, cocaine and methamphetamine to its big brother next door, the US. Mexico's rich and powerful drug cartels have friends both in Mexico's government as well as across the border among US politicians and US drug networks. Cannabis was once one of the drugs that Mexico supplied to the US, but with legalization in many US states, the flow of cannabis has now reversed into Mexico. Mexico legalizing cannabis will add pressure on the US federal government to legalize as well, considering then that both its immediate neighbors, Mexico and Canada, have legal cannabis. So, for Mexico's people, who have fought long and hard for the sacred herb, the forces against them are both within and outside their borders. The Mexican government will do all it can to delay legalization. All the government needs to do, as a simple mediate first step, is legalize home growing, release prisoners jailed for cannabis and expunge their records, while getting its commercial sales aspect right at a later time, like so many US states have done. That would be the case if the interests of the people were foremost, but then, name one government where this is the case?

Apr 30, 2021 4:56:58pm

'Researchers reported that cannabis use among pelvic pain patients rose 32 percent following the legalization of marijuana in Canada. Cannabis users were more likely than non-users to be taking fewer prescription medications, including anti-inflammatory drugs and opioids – a finding that is consistent with dozens of prior studies of other patient populations.

Authors concluded: “Post-legalization, cannabis users were less likely to require daily opioids compared with cannabis users before legalization. The role, perceived benefits, and possible risks of cannabis for pelvic pain require further investigation.”'

https://norml.org/news/2021/04/08/study-fewer-patients-with-pelvic-pain-taking-opioids-following-cannabis-legalization

'George Otto claims he never would have entered the illegal opioid trade if it weren’t for a pharmacist named Shereen El-Azrak. By March 2015, El-Azrak was spiralling from one crisis to another. She co-owned Weston PharmaChoice on Lawrence Avenue near Jane, and the doctor in the adjoining clinic had recently vacated his office. Like many pharmacists in Ontario, El-Azrak needed a physician nearby to write the prescriptions that would make up the backbone of her business. Otto had visited her pharmacy before, and she wanted to form a partnership. It was a common arrangement between doctors and pharmacists: she’d send him patients, he’d send her scripts.'

https://torontolife.com/city/the-untold-story-of-the-doctor-who-fuelled-a-drug-crisis/

'There are several varieties of writing croakers. Some will write only if they are convinced you are an addict, others only if they are convinced you are not. Most addicts put down a story worn smooth by years of use. Some claim gallstones or kidney stones. This is the story most generally used, and a croaker will often get up and open the door as soon as you mention gallstones. I got better results with facial neuralgia after I had looked up the symptoms and committed them to memory. Roy had an operation scar on his stomach that he used to suport his gallstone routine.'

- Junky, William S Burroughs, 1977, originally pub-lished in 1953

'Participants (N = 63) exhibited increased euphoria and decreased anxiety after 45 min of running (RUN) on a treadmill in a moderate-intensity range compared to walking (WALK). RUN led to higher plasma levels of the eCBs anandamide (AEA) and 2-arachidonoglycerol (2-AG). Opioid blockade did not prevent the development of euphoria and reduced anxiety as well as elevation of eCB levels following exercise. Moreover, the fraction of participants reporting a subjective runner's high was comparable in the NAL and PLA-treated group. Therefore, this study indicates that the development of a runner's high does not depend on opioid signaling in humans, but makes eCBs strong candidates in humans, as previously shown in mice.'

https://www.sciencedirect.com/science/article/abs/pii/S0306453021000470

'Researchers reported: “We found that amongst cannabis users, those who use cannabis daily are less likely to have opioid use than people who use cannabis occasionally. This association was present for both men and women.”

They concluded: “For patients using cannabis during treatment, we provide evidence that certain characteristics of cannabis use are associated with less opioid use, including daily use. …

Future studies should further examine specific characteristics and patterns of cannabis use that may be protective or problematic in MAT [medication-assisted treatment].”'

https://norml.org/news/2021/03/04/study-daily-cannabis-use-associated-with-lower-odds-of-opioid-use-among-subjects-in-treatment-for-opioid-use-disorder

'Using data from Truven Health MarketScan Commercial Claims and Encounters Database between 2009 and 2015, we studied the effects of medical and recreational marijuana laws on opioid prescribing in employer-sponsored health insurance. We used a differences-in-differences (DD) approach and found that the implementation of medical marijuana laws (MMLs) and recreational marijuana laws (RMLs) reduced morphine milligram equivalents per enrollee by 7% and 13%, respectively. The reduction associated with MMLs was predominately in people aged 55–64, whereas the reduction associated with RMLs was largely in people aged 35–44 and aged 45–54. Our findings suggest that both MMLs and RMLs have the potential to reduce opioid prescribing in the privately insured population, especially for the middle-aged population.'

https://onlinelibrary.wiley.com/doi/10.1002/hec.4237

'The NFL says it is looking for information about “alternatives to opioids in routine pain management.” The request mentions CBD but is open to research on other cannabinoids.

The request issued Wednesday also mentions research on the “impact of cannabis or cannabinoids on athletic performance.”'

https://hempindustrydaily.com/nfl-requesting-research-on-cbd-for-pain-management/

'The use of acute, short-term residential care for opioid use disorder has grown rapidly, with policy makers advocating to increase the availability of “treatment beds.” However, there are concerns about high costs and misleading recruitment practices. We conducted an audit survey of 613 residential programs nationally, posing as uninsured cash-paying individuals using heroin and seeking addiction treatment. One-third of callers were offered admission before clinical evaluation, usually within one day. Most programs required up-front payments, with for-profit programs charging more than twice as much ($17,434) as nonprofits ($5,712). Recruitment techniques (for example, offering paid transportation) were used frequently by for-profit, but not nonprofit, programs. Practices including admission offers during the call, high up-front payments, and recruitment techniques were common even among programs with third-party accreditation and state licenses. These findings raise concerns that residential programs, including accredited and licensed ones, may be admitting a clinically and financially vulnerable population for costly treatment without assessing appropriateness for other care settings.'

https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00378

'There was one oldtime doctor who lived in a Victorian brownstone in the West Seventies. With him it was simply necessary to present a gentlemanly front. If you could get into his inner office you had it made, but he would write only three prescriptions. Another doctor was always drunk, and it was a matter of catching him at the right time. Often he wrote the prescription wrong and you had to take it back for correction. Then, like as not, he would say the prescription was a forgery and tear it up. Still another doctor was senile, and you had to help him write the script. He would forget what he was doing, put down his pen and go into a long reminiscence about the high class of patients he used to have. Especially, he liked to talk about a man named General Gore who once said to him, "Doctor, I've been to the Mayo Clinic and you know more than the whole clinic put together." There was no stopping him and the exasperated addict was forced to listen patiently. Often the doctor's wife would rush in at the last minute and tear up the prescription, or refuse to verify it when the drugstore called.'

- Junky, William S Burroughs, -1977, originally published in 1953

'Generally speaking, old doctors are more apt to write than the young ones. Refugee doctors were a good field for a while, but the addicts burned them down.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Authors concluded: “The findings of this 42-month time-series analysis revealed a steady and significantly consistent decline in the mean and median MED [morphine equivalent dose] per claim for public payer drug plans. However, when comparing the pre- versus post-legalization time periods, the decline in the mean MED per claim was approximately 5.4 times greater in the period following legalization (22.3 vs. 4.1 mg per claim). In addition, total public payer monthly opioid spending reductions averaged $Can95,000 per month before October 2018 [when adult-use sales were legalized] compared to $Can267,000 per month following the legalization of cannabis. Similar findings were also observed within private drug plans. … The findings of this study add to the growing body of evidence that easier access to cannabis for patients with pain may reduce opioid use and partially offset expenditures for both public and private drug plans.”'

https://norml.org/news/2021/02/04/opioid-prescriptions-decline-in-canada-following-enactment-of-adult-use-marijuana-legalization

'Consistent with prior ecological studies, such as those here, here, and here, investigators “found that increased medical and recreational storefront dispensary counts are associated with reduced opioid related mortality rates during the study period. These associations appear particularly strong for deaths related to synthetic opioids such as fentanyl. Given the alarming rise in the fentanyl-based market in the US, and the increase in deaths involving fentanyl and its analogs in recent years, the question of how legal cannabis availability relates to opioid related deaths is particularly pressing. Overall, our study contributes to understanding the supply side of related drug markets and how it shapes opioid use and misuse.”'

https://norml.org/news/2021/02/04/rising-volume-of-storefront-dispensaries-associated-with-declines-in-opioid-related-fatalities

'Results
Over the 42-month period, the mean MED [morphine equivalent dose]/claim declined within public plans (p < 0.001). However, the decline in MED/claim was 5.4 times greater in the period following legalization (22.3 mg/claim post vs. 4.1 mg/claim pre). Total monthly opioid spending was also reduced to a greater extent post legalization ($Can267,000 vs. $Can95,000 per month). The findings were similar for private drug plans; however, the absolute drop in opioid use was more pronounced (76.9 vs. 30.8 mg/claim). Over the 42-month period, gabapentin and pregabalin usage also declined.

Conclusions
Our findings support the hypothesis that easier access to cannabis for pain may reduce opioid use for both public and private drug plans.'

https://link.springer.com/article/10.1007%2Fs40258-021-00638-4

'Doctors are so exclusively nurtured on exaggerated ideas of their position that, generally speaking, a factual approach is the worst possible. Even though they do not believe your story, nonetheless they want to hear one. It is like some Oriental face-saving ritual. One man plays the high-minded doctor who wouldn't write an unethical script for a thousand dollars, the other does his best to act like a legitimate patient. If you say, "Look, Doc, I want an M.S. script and am willing to pay double price for it," the croaker blows his top and throws you out of the office. You need a good bedside manner with doctors or you will get nowhere.'

- Junky, William S Burroughs, 1977, originally published in 1953

'“Our findings suggest that increasing availability of legal cannabis (modeled through the presence of medical and recreational dispensary operations) is associated with a decrease in deaths associated with the T40.4 class of opioids, which include the highly potent synthetic opioid fentanyl,” it continues. “This finding is especially important because fentanyl related deaths have become the most common opioid related cause of death.”'

https://www.marijuanamoment.net/areas-with-more-marijuana-dispensaries-have-fewer-opioid-deaths-new-study-finds/

'Results
Of the 1,000 patients consented, 757 (76%) participated at one or more of the study time points.

At six and 12 months, 230 (30.4%) and 104 (13.7%) of participants were followed up, respectively.

Most participants were female (62%), Caucasian (91%), and sought cannabis for pain relief (88%). Time was a significant factor associated with improvement in pain intensity (P < 0.001), pain-related interference scores (P < 0.001), QoL (P < 0.001), and general health symptoms (P < 0.001). Female sex was significantly associated with worse outcomes than male sex including pain intensity (P < 0.001) and pain-related interference (P < 0.001). The proportion of individuals who reported using opioids decreased by half, from 40.8% at baseline to 23.9% at 12 months.'

https://link.springer.com/article/10.1007/s12630-020-01903-1

'Patients authorized to use medical cannabis significantly reduce or eliminate their use of opioids over time, according to longitudinal data published in the Canadian Journal of Anaesthesia.

A team of Canadian investigators assessed self-reported opioid consumption patterns over time in a cohort of authorized medical cannabis patients who suffered from pain-related issues.

Consistent with numerous other studies, researchers reported that many subjects tapered their use of opioids following medical cannabis initiation. “The proportion of individuals who reported using opioids decreased by half” over a period of twelve months, they determined.'

https://norml.org/blog/2021/01/21/study-nearly-half-of-medical-cannabis-users-cease-using-opioids-for-pain-after-twelve-months/

'As I began using stuff every day, or often several times a day, I stopped drinking and going out at night. When you use junk you don't drink. Seemingly, the body that has a quantity of junk in its cells will not absorb alcohol. The liquor stays in the stomach, slowly building up nausea, discomfort, and dizziness, and there is no kick. Using junk would be a sure cure for alcoholics. I also stopped bathing. When you use junk the feel of water on the skin is unpleasant for some reason, and junkies are reluctant to take a bath.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Investigators with the University of Victoria in Vancouver assessed prescription drug use patterns over a six-month period in a cohort of 1,145 authorized medical cannabis patients.

Researchers reported that 28 percent of subjects acknowledged using opioid medications at the initiation of the trial. This fell to 11 percent six months later. Participants’ mean opioid dosage fell by 78 percent over the trial period – a finding consistent with prior studies.

Researchers also reported declines in subjects’ use of prescription anti-depressants, benzodiazepines, and anti-seizure medications. Prior studies have similarly reported declines in patients use of benzodiazepines and other prescription medications following the initiation of medical cannabis.'

https://norml.org/news/2021/01/21/study-medical-marijuana-treatment-associated-with-significant-declines-in-the-use-of-opioids-at-six-months

'“The results of the Tilray Observational Patient Study (TOPS) add to a growing body of evidence that cannabis use can lead to a reduction in the use of prescription drugs, alcohol, tobacco, and other substances” Philippe Lucas, lead study author, said in a press release.

“In light of the devastating impacts of the opioid overdose crisis in Canada and around the world, research examining the potential influence of cannabis on opioid use may be of particular importance to public health, and these findings could inform harm reduction strategies to mitigate the significant morbidity and mortality associated with opioids,” he said.

There were also similar reductions in the four other drug categories that the study investigated: non-opioid pain medication, anti-depressants, benzodiazepines and anti-seizure drugs.'

https://www.marijuanamoment.net/medical-marijuana-leads-to-reduced-opioid-use-new-study-finds/

'The analysis looked at nine separate studies involving a total of 7,222 participants across the U.S., Canada and Australia that "found a much higher reduction in opioid dosage, reduced emergency room visits, and hospital admissions for chronic non-cancer pain by (medical cannabis) users, compared to people with no additional use of" medical cannabis.

Those studies confirm Larson’s assertion: There was a 64% to 75% reduction in opioid dosage when patients supplemented their chronic pain treatments with medical cannabis, and 32% to 59% of cannabis users reported a complete end to opioid use.'

https://www.politifact.com/factchecks/2020/nov/20/lyle-larson/studies-show-cannabis-can-lower-opioid-dosage-stud/

'We were having trouble filling the scripts. Most drugstores will only fill a morphine script once or twice, many not at all. There was one drugstore that would fill all our scripts anytime, and we took them all there..'

- Junky, William S Burroughs, 1977, originally published in 1953

'Highlights
- Cannabis use is common among patients receiving medication-based treatment for opioid use disorder (MOUD).
- We summarize findings from 41 studies that documented cannabis use during MOUD (methadone, buprenorphine, or naltrexone).
- In most studies, cannabis use did not significantly predict treatment outcomes (opioid use, adherence, retention).
- A small number of studies documented poorer outcomes, and a small number documented better outcomes for cannabis users.
- While experimental research is warranted, current evidence suggests cannabis use is unlikely to undermine MOUD progress.'

https://www.sciencedirect.com/science/article/abs/pii/S0272735820301276

'Results
1045 patients completed the baseline questionnaires and initiated MC treatment, and 551 completed the 12 month follow-up. At one year, average pain intensity declined from baseline by 20% [-1.97 points (95%CI= -2.13 to -1.81; p<0.001)]. All other parameters improved by 10-30% (p<0.001). A significant decrease of 42% [reduction of 27mg; (95%CI= -34.89 to -18.56, p<0.001)] from baseline in morphine equivalent daily dosage of opioids was also observed. Reported adverse effects were common but mostly non-serious. Presence of normal to long sleep duration, lower body mass index (BMI) and lower depression score predicted relatively higher treatment success, whereas presence of neuropathic pain predicted the opposite.

Conclusions
This prospective study provides further evidence for the effects of MC on chronic pain and related symptoms, demonstrating an overall mild to modest long-term improvement of the tested measures and identifying possible predictors for treatment success.'

https://onlinelibrary.wiley.com/doi/10.1002/ejp.1675

'There were no between-group differences based on demographic, experiential, or attitudinal variables. We found that 50.8% were able to stop all opioid usage, which took a median of 6.4 years (IQR=1.75–11 years) after excluding two patients who transitioned off opioids by utilizing opioid agonists. For those 29 patients (47.5%) who did not stop opioids, 9 (31%) were able to reduce opioid use, 3 (10%) held the same baseline, and 17 (59%) increased their usage. Forty-eight percent of patients subjectively felt like cannabis helped them mitigate their opioid intake but this sentiment did not predict who actually stopped opioid usage. There were no variables that predicted who stopped opioids, except that those who used higher doses of cannabis were more likely to stop, which suggests that some patients might be able to stop opioids by using cannabis, particularly those who are dosed at higher levels.

Conclusions: In this long-term observational study, cannabis use worked as an alternative to prescription opioids in just over half of patients with low back pain and as an adjunct to diminish use in some chronic opioid users.'

https://www.liebertpub.com/doi/10.1089/can.2019.0039

'A lot of nonsense has been written about the changes people undergo as they get a habit. All of a sudden the addict looks in the mirror and does not recognise himself. The actual changes are difficult to specify and they do not show up in the mirror. That is, the addict himself has a special blind spot so far as the progress of the habit is concerned. He generally does not realize that he is getting a habit at all. He says there is no need to get a habit if you are careful and observe a few rules, like shooting every other day. Actually, he does not observe these rules, but every extra shot is regarded as exceptional. I have talked to many addicts and they all say they were surprised when they discovered they actually had the first habit. Many of them attributed their symptoms to some other cause.'

- Junky, William S Burroughs, 1977, originally published in 1953

'A converging line of evidence is indicating that cannabinoids may have an opioid-sparing effect. This property, well validated in preclinical studies, allow when both drugs are co-administered to reduce the dose of opioids without loss of analgesic effects. A meta-analysis of pre-clinical studies indicated in 2017 that the median effective dose (ED50) of morphine administered in combination with delta-9-tetrahydrocannabinol (delta-9-THC) is 3.6 times lower than the ED50 of morphine alone (Nielsen et al., 2017). However, very few studies have been conducted in humans to validate this effect. This narrative review provides an update on whether or not cannabinoid drugs can be used to produce an opioid sparing effect.'

https://www.sciencedirect.com/science/article/abs/pii/S027858462030381X

'Results. Between 2005 and 2018, at-least-daily cannabis use was associated with swifter rates of injection cessation (adjusted hazard ratio [AHR]=1.16; 95% confidence interval [CI]=1.03, 1.30). A subanalysis revealed that this association was only significant for opioid injection cessation (AHR=1.26; 95% CI=1.12, 1.41). At-least-daily cannabis use was not significantly associated with injection relapse (AHR=1.08; 95% CI=0.95, 1.23).

Conclusions. We observed that at-least-daily cannabis use was associated with a 16% increase in the hazard rate of injection cessation, and this effect was restricted to the cessation of injection opioids. This finding is encouraging given the uncertainty surrounding the impact of cannabis policies on PWID during the ongoing opioid overdose crisis in many settings in the United States and Canada.'

https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2020.305825

'The study’s authors concluded: “These observations are encouraging given the uncertainty surrounding the impact of cannabis legalization policies during the ongoing opioid overdose crisis in many settings in the United States and Canada, particularly among PWID [people who inject drugs] who are at increased risk for drug-related harm. The accumulating evidence from preclinical and epidemiological studies linking cannabis use to opioid use behaviors further supports the evaluation of the therapeutic benefits of cannabis and specific cannabinoids (e.g., CBD and THC) for people living with opioid use disorder.”'

https://norml.org/news/2020/08/27/study-cannabis-associated-with-increased-cessation-of-iv-opioid-use

'They concluded, “In the first randomized clinical trial of cannabidiol for cannabis use disorder, cannabidiol [doses of] 400 mg and 800 mg were safe and more efficacious than placebo at reducing cannabis use.”

Prior clinical trials have reported that CBD administration is associated with reduced cravings for both heroin and tobacco. A literature review published in the journal Substance Abuse: Research and Treatment previously concluded, “CBD seems to have direct effects on addictive behaviors.”'

https://norml.org/news/2020/08/06/clinical-trial-cbd-administration-associated-with-greater-likelihood-of-cannabis-abstinence-among-those-seeking-to-quit

'Data show that, after cannabis, the drug for which the most people are brought into contact with the criminal justice system is the drug that dominates the market in a particular region. In Asia in particular, ATS are the major drug group for which people are brought into contact with the criminal justice system, most likely as a result of the wide use and trafficking of methamphetamine in the region. For both males and females, offences related to ATS are predominant among those brought into contact with the criminal justice system for possession for personal use. In the case of trafficking, the data show different patterns for men and women. Among those brought into contact with the criminal justice system for drug trafficking in Asia, for those who are men, ATS, opioids and cannabis account for similar proportions of cases (each drug group accounts for about a third of cases), while for women, ATS account for 60 per cent of cases, followed by opioids (which account for a third). Cocaine-related offences are particularly prevalent in the Americas, reflecting the extent of cocaine supply and trafficking in the region. Among those brought into contact with the criminal justice system for drug trafficking in the Americas, cocaine accounts for about 40 per cent, with similar proportions of men and women.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'As a habit takes hold, other interests lose importance to the user. Life telescopes down to junk, one fix and looking forward to the next, "stashes" and "scripts," "spikes" and "droppers." The addict himself often feels that he is leading a normal life and that junk is incidental. He does not realize that he is just going through the motions in his non-junk activities. It is not until his supply is cut off that he realizes what junk means to him.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Affordability is addressed, among other ways, by ensuring funding for the purchase of opioid medications as well as developing and improving health insurance and reimbursement schemes that guarantee access to pain medication. In 2018, 50 countries reported to INCB that steps had been taken towards improving their health insurance systems and setting affordable prices for essential medicines, including opioids. However, limited resources can impair even a well-intended Government from procurement or preclude it from providing or subsidizing controlled medicines for pain management. Other issues that may affect the affordability of pain medications include licensing, taxation, poor or inefficient distribution systems, lack of reimbursement and lack of availability of inexpensive formulations. Even in the case of Governments that are strongly committed to addressing challenges and barriers to access, financial resources may not be available to make systemic changes. Moreover, because of the high cost of pain medications, in many high-income countries and in most low- and middle-income countries, where a large number of people are not covered by either health insurance or a national health-care system, many people can encounter difficulties in accessing the pain medications that they need'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Countries report that import and export control measures or restrictions are among the main impediments to ensuring the availability of controlled substances. To address this, INCB has introduced a number of online and electronic systems to streamline and simplify import and export processes within countries. One improvement over the years has been the gradual establishment of electronic tools for processing import and export authorizations, with competent national authorities in 50 countries reporting the use of such tools in 2018. In addition, with a view to facilitating the production of reliable estimates of the quantities of controlled substances needed nationally, guidelines for estimating the national requirements of controlled substances have also been made available in recent years. Nevertheless, many countries, for a myriad of reasons, continue to report to INCB that they are unable to properly estimate or to monitor consumption of controlled substances and continue to inadequately or insufficiently estimate opioid requirements'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'By contrast, the availability of pharmaceutical opioids for medical purposes declined by almost 50 per cent in North America, from 32,550 S-DDD per day per million inhabitants in 2010 to 16,910 S-DDD in 2018, thus approaching the levels reported in Western and Central Europe (12,660 S-DDD) and in Australia and New Zealand (10,530 S-DDD) in 2018. Nevertheless, per capita availability of pharmaceutical opioids for medical purposes in North America remains comparatively high (almost eight times the global average), in particular when compared with the extremely low levels in Africa and South Asia, as well as in Central Asia and Transcaucasia, where there are no signs of increases.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'The doctor's office was in junk territory on 102nd, off Broadway. He was a doddering old man and could not resist the junkies who filled his office and were, in fact, his only patients. It seemed to give him a feeling of importance to look out and see an office full of people. I guess he had reached a point where he could change the appearance of things to suit his needs and when he looked out there he saw a distinguished and diversfied clientele, probably well dressed in 1910 style, instead of a bunch of ratty-looking junkies come to hit him for a morphine script.'

- Junky, William S Burroughs, 1977, originally published in 1953

'In recent years the huge disparity between countries in the accessibility of opioids for medical purposes has been reduced slightly: declines in opioids available for medical consumption are reported in North America, while overall increases are reported in several other subregions, most notably South America and the Near and Middle East/South-West Asia, where availability has been low. This suggests an overall increase in the availability of opioids in developing countries, although that availability was starting from, and remains at, a low level. Daily per capita availability of pharmaceutical opioids more than doubled in the regions and subregions where availability was below the global average (i.e., Africa, Asia, South America, Central America, the Caribbean, Eastern and South-Eastern Europe, Melanesia, Micronesia and Polynesia); taken together, availability in these regions and subregions increased from an average of 70 S-DDD per million inhabitants in 2010 to 180 S-DDD in 2018 (7 per cent of the global per capita average)'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Other than opioids, non-steroidal anti-inflammatory drugs are used in patients with osteoarthritis and rheumatoid arthritis and low back pain. The efficacy of antidepressant drugs has been reported for the management of neuropathic pain, fibromyalgia, low back pain and headaches. Anti-convulsant drugs such as gabapentin, pregabalin and carbamazepine have proved effective in the treatment of chronic non-cancer pain. As part of complementary and alternative medicine, spinal manipulation is the most commonly used therapy for low back pain. Massage is another modality commonly used as a supplemental treatment for patients with chronic non-cancer pain. Similarly, evidence supports the effectiveness of acupuncture for the treatment of chronic low back pain, while results on the effectiveness of acupuncture in the reduction of pain associated with fibromyalgia and neck pain are promising. Psychological interventions such as cognitive behavioural therapy, relaxation training and hypnosis are the most commonly used techniques in the management of chronic pain. The aim of such interventions is to help the patient cope with the symptoms of pain, learn skills for adaptation and self-management, and reduce disability associated with symptoms, rather than eliminate physical causes of pain per se.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'The use of strong opioids, especially morphine, is generally considered the principal treatment for the management of pain in palliative care for cancer patients. The treatment of chronic non-cancer pain, which is among the most prevalent health conditions in many countries, is often considered more difficult to manage, and its treatment is sometimes more controversial. Chronic non-cancer pain is defined in scientific literature as pain lasting for more than three months that stems from injuries or illnesses other than cancer. It is also considered that chronic pain results from a combination of biological, psychological and social factors, and thus requires a multifactorial approach to pain assessment, patient monitoring and evaluation and long-term management. Some of the common conditions that cause chronic pain include neuropathic pain, fibromyalgia that may be caused by damage to the peripheral or central nervous system, low back pain and osteoarthritis. While opioids are used extensively in the management of non-cancer chronic pain in some countries and settings, in others, other drugs, as well as complementary and alternative medicines, are used effectively in the management of chronic pain whether related to cancer or not.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'All croakers pack in sooner or later. One day when Roy came for his script, the doctor told him, "This is positively the last, and you guys had better keep out of sight. The inspector was around to see me yesterday. He has all the R-xes I wrote for you guys. He told me I will lose my license if I write any more, so I'm going to date this one back. Tell the druggist you were too sick yesterday to cash it.'

- Junky, William S Burroughs, 1977, originally published in 1953

'In 2018, 87 per cent of the global amount of morphine available for medical consumption was estimated to have been consumed in high-income countries, which are home to 12 per cent of the global population. While the relative importance of the amounts of morphine available for medical consumption in low- and middle-income countries has increased slightly since 2014 (from 9.5 to 13 per cent in 2018) the amount of morphine available per person per country is still infinitesimally small to non-existent in many developing countries, particularly in South Asia and in Africa. Even though countries may have morphine available for medical use, many people still have limited access to it. WHO estimates that globally, each year 5.5 million terminal cancer patients and 1 million end-stage HIV/AIDS patients do not have adequate treatment for moderate to severe pain'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Data also show discrepancies in the kind of pharmaceutical opioids available on the medical market. While data for North America show that hydrocodone is the most widely available pharmaceutical opioid (in terms of daily doses per inhabitant), fentanyl is the most widely available opioid in Western and Central Europe and in Australia and New Zealand. The availability for medical consumption of oxycodone is also relatively high in Australia and New Zealand and in North America. By contrast, the availability of codeine for medical consumption appears to be quite limited, although this may be a statistical artefact as most codeine is sold in the form of preparations, the sale of which – falling under Schedule III of the 1961 Single Convention – is internationally less strictly controlled and thus less well documented than the sale of other pharmaceutical opioids'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Data show that there is a generally positive correlation between gross national income and the availability of pharmaceutical opioids for medical purposes (R=0.67 over the period 2014–2018), although a number of Asian countries and territories with high gross national income per capita (such as Macao, China, Hong Kong, China, Qatar, Singapore, Japan and Kuwait) have very low levels of opioid availability for medical purposes. This suggests that the level of national income is not the only factor that explains unequal availability across countries. A number of barriers to access to opioids for pain management are related to legislation, culture, health systems and prescribing practices. '

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Even within each region or subregion, there is a significant disparity in the consumption of opioids for medical purposes. Over the period 2014–2018, average consumption of opioids in countries in North America ranged from some 100 defined daily doses for statistical purposes (S-DDD) per million inhabitants in Mexico to 32,700 S-DDD per million inhabitants in the United States of America. Similarly, in Western and Central Europe, estimates ranged from close to 500 S-DDD per million inhabitants in Malta to 25,800 S-DDD per million inhabitants in Germany. In Oceania, estimates ranged from, on average, 15 S-DDD per million inhabitants in Vanuatu to close to 11,600 S-DDD per million inhabitants in Australia, and in Asia, from 0.1 S-DDD per million inhabitants in Yemen to close to 11,300 S-DDD per million inhabitants in Israel.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Ten minutes later Herman arrived. The brother-in-law was giving him the same treatment when Herman pulled out a silk dress he had under his coat - as I recall somebody unloaded a batch of hot dresses on us for three grains of morphine - and turning to see the doctor's wife who had come downstairs to see what all the commotion was about, he said, "I thought you might like this dress." So he got a chance to talk to the doctor who wrote him one last script. It took him three hours to fill it. Our regular drug store had been warned by the inspector, and they would not fill any more scripts.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Data for 2018 show that more than 90 per cent of all pharmaceutical opioids that are available for medical consumption are in high-income countries: 50 per cent in North America, around 40 per cent in Europe, mostly in Western and Central Europe, and a further 2 per cent in Oceania, mostly Australia and New Zealand. Those high-income countries comprise around 12 per cent of the global population. Therefore, low- and middle-income countries, which are home to some 88 per cent of the global population, are estimated to consume less than 10 per cent of the global amount of opioids available for medical consumption.'

- United Nations Office on Drugs and Crime, World Drug Report 2020,

https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'The amounts available for medical consumption of some of the other synthetic opioids used in pain management have been declining over the past two decades. Pethidine is one example, with a 70 per cent decline over the period 1998–2018, while amounts available for medical consumption of dextropropoxyphene, which was very popular in the 1990s, have decreased by more than 99 per cent over the past two decades as the substance was banned in a number of countries owing to concerns over serious side effects. The amount of fentanyl available for medical consumption increased until 2010 but remained largely stable thereafter. By contrast, the amounts of buprenorphine and methadone available for medical consumption and used in the medically assisted treatment of opioid use disorders, have increased since 2014, especially of buprenorphine, which rose by more than 50 per cent over the period 2014–2018.10 However, as with other pharmaceutical opioids, there are large differences from one country to another in the consumption patterns of buprenorphine and methadone for medical purposes, as seen in the coverage of opioid-agonist treatment for people with opioid use disorders.'

- United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'Access to and availability of controlled medicines for pain relief, i.e., opioids, are unequally distributed across the geographical regions and have had diverging trends in different regions. The amount of opioids (expressed in daily doses) available for consumption for medical purposes more than doubled globally over the period 1998–2010, followed by a period of stabilization and a decline over the period 2014–2018. Most of the increase in the amount of pharmaceutical opioids available for medical consumption over the period 1998–2010 was of oxycodone (which experienced a tenfold growth over that period), hydromorphone (fivefold growth), hydrocodone (threefold growth) and oxymorphone (46,000-fold growth). Methadone and buprenorphine, the opioids used in medically assisted treatment of opioid use disorders, also saw marked increases in the amounts available for medical consumption at the global level. The amount of fentanyl available for medical consumption rose ninefold over the period 1998–2010. Moreover, since 2000, only about 10 per cent of globally available morphine was reported to have been used for palliative care while over 88 per cent was converted into codeine, the majority of which (89 per cent) was used to manufacture cough medicines.'

- United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_6.pdf

'The announcement by the three-time Super Bowl champion instantly raised the profile of a substance that is exploding in popularity, even as questions swirl about its legality and medical effectiveness. Though Gronkowski is the latest in a long line of celebrities to promote CBD, his endorsement could signal a key moment in the drug’s evolving acceptance among sports leagues and consumers.'
https://www.bostonglobe.com/news/marijuana/2019/08/27/rob-gronkowski-announces-partnership-with-cbd-company-says-cbd-most-safe-alternative-for-pain/a5K8hCzCLuOWEm7CScdFFJ/story.html

'Our croaker had packed in. We split up to comb the city. We covered Brooklyn, the Bronx, Queens, Jersey City and Newark. We couldn't even score for pantopon. It seemed like the doctors were all expecting us, just waiting for one of us to walk into the office so they could say, "Absolutely no." It was as though every doctor in Greater New York had suddenly taken a pledge never to write another narcotics script. We were running out of junk.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Our findings demonstrate that THC produced robust antinociception equivalent to the whole extract in models of thermal and inflammatory nociception. Thus, other cannabinoid constituents including terpenes do not add to the analgesic actions of cannabis beyond that of isolated THC. This analgesia across several pain models suggest a range of clinical applications for THC.'
https://www.liebertpub.com/doi/10.1089/can.2018.0054

'The purpose of this Notice is to inform potential applications to the National Institute on Drug Abuse (NIDA) and National Institute on Aging (NIA) of special interest in grant applications to conduct rigorous research on cannabis and potentially addictive, psychoactive prescription drug use (specifically opioids and benzodiazepine) in older adults. This program will focus on two distinct older adult populations (over the age of 50): (1) individuals with earlier use onset of cannabis and the specified drug classes who are now entering older age, or (2) individuals who initiate use of cannabis and the specified drug classes after the age of 50. Insights gained from this initiative have the potential to inform the public and health care systems regarding use of cannabis and prescription opioids and benzodiazepines in older populations.'
https://grants.nih.gov/grants/guide/notice-files/NOT-DA-20-014.html

'Moreover, many of the studies have overlooked the proliferation of fentanyl as a driver of opioid overdose mortality in the United States, which may negate any potential effect of medical cannabis on overdose deaths. It can only be concluded that additional research might help to identify a range of alternative non-opioid medications and non-pharmacological treatments that could be effective in pain management. The issue of whether increased accessibility of cannabis could reduce the medical and non-medical use of pharmaceutical opioids and their negative impact remains inconclusive.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Out of the nearly 9,000 respondents, 5 per cent reported ever using cannabis and had used opioids in the past year, among whom 43 per cent had used opioids daily and 23 per cent had used cannabis in the past 30 days. Although the results are based on a small number of respondents, of the 450 who reported ever using cannabis and past-year opioid use, 41 per cent reported a decrease or cessation of opioid use as a result of cannabis use, 46 per cent reported no change in opioid use and 8 per cent reported an increase in opioid use' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'I got a codeine script from an old doctor by putting down a story about migraine headaches. Codeine is better than nothing and five grains in the skin will keep you from being sick. For some reason, it is dangerous to shoot codeine in the vein.'

- Junky, William S Burroughs, 1977, originally published in 1953

'With regard to cannabis products substituting for opioids as pain relief medication, it is considered that the analgesic effects of cannabis are not sufficiently powerful to palliate acute pain or to manage chronic pain. For example, only in very specific cases have preparations containing THC, such as dronabinol and nabiximols, been shown to be effective in the management of neuropathic pain in patients suffering from multiple sclerosis. A long-term longitudinal study among people who were prescribed opioids showed greater pain severity and pain interference (pain effects on sleep, working ability, daily living, social interactions, lower pain self-efficacy and higher levels of generalized anxiety disorder) among the 24 per cent who also used cannabis daily or less frequently than among those who did not use cannabis. Moreover, individuals who used cannabis on a near-daily basis were less likely to discontinue opioid use than participants who abstained from cannabis use' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Special Guests David Clarenbach, Benjamin Tyler, Mitch Young and Paul Armentano.

Lots of perspectives on Cannabis and Opioid Addiction.'

https://talk927fm.com/podcast/7-8-20-wiscannabis-radio/

'The percentage of chronic pain patients using cannabis therapeutically is increasing, according to data published in the journal Advances in Therapy.

Investigators affiliated with Harvard Medical School assessed trends in cannabis use among pain patients in a nationally representative sample during the years 2011 to 2015.

Authors reported, “Over the course of our study, … we identified a significant and progressive increase in the number of patients using cannabis. In patients with chronic pain, cannabis use more than doubled during this period.”

They reported that the average age of chronic pain patients who consumed cannabis was 45 and that the majority of users were lower on the socioeconomic scale than were non-users.'
https://norml.org/blog/2020/07/14/cannabis-use-rising-among-chronic-pain-patients/

'Nearly three in four licensed health care professionals in Washington state endorse the use of medical cannabis as a substitute for opioids in patients with chronic pain, according to survey data published in the journal Cannabis and Cannabinoid Research.

Researchers with the University of Washington School of Nursing surveyed a random sampling of actively licensed health care professionals legally permitted to provide medical cannabis authorizations in the state of Washington.

Of eligible respondents, 72 percent agreed with the statement, “Medical marijuana should be used to reduce the use of opioids for non-cancer pain.” Several studies [links] report that pain patients enrolled in state-sponsored cannabis access programs reduce or eliminate their use of opioid pain relievers over time.'
https://norml.org/blog/2020/07/15/survey-majority-of-health-care-professionals-endorse-cannabis-use-instead-of-opioids-in-chronic-pain-patients/

'Tea heads are not like junkies. A junkie hands you the money, takes his junk and cuts. But tea heads don't do things that way. They expect the peddlar to light them up and sit around talking for half an hour to sell two dollars worth of weed. If you come right to the point, they say you are a "bring down." In fact, a peddlar should not come right out and say he is a peddlar. No, he just scores for a few good "cats and "chicks" because he is viperish. Everyone knows that he himself is the connection, but it is bad form to say so. God knows why. To me, tea heads are unfathomable.'

- Junky, William S Burroughs, 1977, originally published in 1953

'These fourteen newly designated assembly points are on mostly tall buildings with spacious rooftops in downtown Saigon, to which we can all flee and be picked up by U.S. Marine helicopters and ferried out to one of the Seventh Fleet aircraft carriers waiting offshore, then whisked off to the safety of the U.S. Naval base at Subic Bay in the Philippines.

This is all stone madness, of course. If an incoming rocket blew the lobby of this hotel from under me right now, I would quickly consult the emergency evacuation instructions and see that my "assembly point" is "3 Phan Van Dat" - which means absolutely nothing to me; it might as well be the address of a Coptic massage parlour in Macao, or maybe the street name of the number-three son of a once-proud South Vietnamese family, who recently turned to opium and bought himself a few suits of tailor-made, black-silk pajamas.

Perhaps some of the veteran war correspondents sleeping in the high-ceilinged, tile-floored rooms up and down the dark hallway from mine, know exactly what "3 Phan Van Dat" means...But I am the only English-speaking person awake at the Continental at this hour, and even if I rushed out in the hall and began kicking savagely on every door I can reach - screaming: "Banzai! The jig is up!" - it wouldn't cause much of a rumble, because at least half of the denizens of this elegant French colonial hotel tonight are either drunk, stoned, or helplessly paralyzed by opium.'

- Interdicted Dispatch from the Global Affairs Desk, May 22, 1975, Fear and Loathing at the Rolling Stone, The Essential Writing of Hunter S. Thompson

'Drug overdose deaths involving selected drug categories are identified by specific multiple cause-of-death codes. Drug categories presented include: heroin (T40.1); natural opioid analgesics, including morphine and codeine, and semisynthetic opioids, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone (T40.2); methadone, a synthetic opioid (T40.3); synthetic opioid analgesics other than methadone, including drugs such as fentanyl and tramadol (T40.4); cocaine (T40.5); and psychostimulants with abuse potential, which includes methamphetamine (T43.6). Opioid overdose deaths are identified by the presence of any of the following MCOD codes: opium (T40.0); heroin (T40.1); natural opioid analgesics (T40.2); methadone (T40.3); synthetic opioid analgesics other than methadone (T40.4); or other and unspecified narcotics (T40.6).'
https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

'Results
At T0, neurophysiological variables did not differ significantly between patients and controls. At T1, spasticity and pain scores improved, as detected by the Modified Ashworth Scale or MAS (p=0.001), 9-Hole Peg Test or 9HPT (p=0.018), numeric rating scale for spasticity or NRS (p=0.001), and visual analogue scale for pain or VAS (p=0.005). At the same time, the CSP was significantly prolonged (p=0.001).

Conclusions
The THC-CBD spray improved spasticity and pain in secondary progressive MS patients. The spray prolonged CSP duration, which appears a promising tool for assessing and monitoring the analgesic effects of THC-CBD in MS [multiple sclerosis].'
https://onlinelibrary.wiley.com/doi/abs/10.1111/ane.13313

'In 1937, weed was placed under the Harrison Narcotics Act. Narcotics authorities claim it is a habit-forming drug, that its use is injurious to mind and body, and that it causes the people who use it to commit crimes. Here are the facts: Weed is positively not habit forming. You can smoke weed for years and you will experience no discomfort if your supply is cut off. I have seen tea heads in jail and none of them showed withdrawal symptoms. I have smoked weed myself off and on for fifteen years, and never missed it when I ran out. There is less habit to weed than there is to tobacco. Weed does not harm the general health. In fact. most users claim it gives you an appetite and acts as a tonic to the system. I do not know of any other agent that gives as definite a boot to the appetite. I can smoke a stick of tea and enjoy a glass of California sherry and a hash house meal.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Current users and PU [past users] took MC [Medical Cannabis] to address pain (65.30%), spasms (63.30%), sleeplessness (32.70%), and anxiety (24.00%), and 63.30% reported it offered “great relief” from symptoms. Participants reported that MC is more effective and carries fewer side effects than prescription medications.

Conclusions
Medicinal cannabis is an effective and well-tolerated treatment for a number of SCI[Spinal Cord injury]-related symptoms.'
https://www.nature.com/articles/s41394-019-0208-6

'The purpose of this systematic review was to explore available peer-reviewed evidence related to the use of cannabis as a potential alternative to opioids in the treatment of chronic pain. The Johns Hopkins Nursing Evidence-Based Practice model was used to review 32 peer-reviewed articles published between 2008 and 2018. Findings suggest cannabis as a promising alternative to opioids and supports the medical use of cannabis as a safer first-line pharmacological treatment for chronic pain compared to opioids. The use of cannabis as a safer alternative to opioids can promote social change directly and indirectly across a variety of social and economic dimensions due to increased access to medication at reduced cost, elimination of opioid-related death due to overdose, diminished individual and social harms related to cannabis. A medical alternative to opioids may also lead to a reduction of the inequitable incarceration of cannabis users across demographic categories of ethnicity and race.'
https://search.proquest.com/openview/a69d6774a45ea04c630c10a84ea2cc8e/1?pq-origsite=gscholar&cbl=18750&diss=y

'“Marijuana is less habit forming than opiates and carries virtually no risk of fatal overdose, thus it has been wrongly classified,” says Rajiv Kafle, a prominent legalisation activist. “Moreover, when the drug was banned it was done without proper scientific research. Studies have shown that the chemical cannabidiol found in marijuana has beneficial medical properties.”

Activists also say that marijuana can help control crime and wean the dependency on other hard drugs. The most vivid proof of that is KC, who did heroin for 22 years. He says marijuana coul be added to harm reduction in drug rehab in Nepal if it was available legally.

“Take it from me, marijuana was my saviour. It made my pain bearable and took away my addiction to heroin. Believe me, many heroin addicts like me would give up heroin,” says KC. Activists say that legalising marijuana will help patients to get high quality cannabis for their conditions, and by regulating the drug, the government can keep a tab on the criminality associated with it.'
https://archive.nepalitimes.com/article/nation/undo-hash-ban,3657

'I once kicked a junk habit with weed. The second day off junk I sat down and ate a full meal. Ordinarily, I can't eat for eight days after kicking a habit.'

- Junky, William S Burroughs, 1977, originally published in 1953

'There is also - at least in the minds of at least two dozen gullible sportswriters at the Super Bowl - the ugly story of how I spent three or four days prior to Super Week shooting smack in a $7-a-night motel room on the seawall in Galveston.

I remember telling the story one night in the press lounge at the Hyatt Regency, just babbling it off the top of my head out of sheer boredom...Then I forgot about it completely until one of the local sportswriters approached me a day or so later and said: "Say, man, I hear you spent some time in Galveston last week."

"Galveston?"

"Yeah," he said. "I hear you locked yourself in a motel over there and shot heroin for three days."

I looked around me to see who was listening, then grinned kind of stupidly and said, "Shucks, there wasn't much else to do, you know - why not get loaded in Galveston?"

He shrugged uncontrollably and looked down at his Old Crow and water. I glanced at my watch and turned to leave. "Time to hit it," I said with a smile. "See you later, when I'm feeling back on my rails."

He nodded glumly as I moved away in the crowd...and although I saw him three or four times a day for the rest of that week, he never spoke to me again.'

- Fear and Loathing at the Super Bowl, February 28, 1974, Fear and Loathing at the Rolling Stone, The Essential Writing of Hunter S. Thompson

'The Canadian Association of Chiefs of Police (CACP) said that its recommendation is motivated by an interest in reducing overdose deaths and promoting treatment. This announcement comes two years after the organization created a commission tasked with studying decriminalization, the results of which were released in a new report.

“Canada continues to grapple with the fentanyl crisis and a poisoned drug supply that has devastated our communities and taken thousands of lives,” CACP President Adam Palmer said in a press release. “We recommend that enforcement for possession give way to an integrated health-focussed approach that requires partnerships between police, healthcare and all levels of government.“'
https://www.marijuanamoment.net/top-canadian-police-association-says-its-time-to-decriminalize-all-drugs/

'When you're sick, music is a great help. Once, in Texas, I kicked a habit on weed, a pint of paregoric and a few Louis Armstrong records.'

- Junky, William S Burroughs, 1977, originally published in 1953

'The main concern for the authorities in a number of countries has been the emergence of new synthetic opioid receptor agonists (NPS with opioid effects), often fentanyl analogues, in recent years. Although fewer in number than other NPS categories, they have proved to be particularly potent and harmful, leading to increasing numbers of overdose deaths, in particular in North America and, to a lesser extent, in Europe and other regions.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The bulk of tramadol seized in the period 2014– 2018 was seized in West and Central Africa (notably in Nigeria, Benin, Côte d’Ivoire and the Niger), followed by North Africa (notably Egypt, Morocco and the Sudan) and the Near and Middle East (notably Jordan and the United Arab Emirates). In some instances, countries in Western and Central Europe (notably Malta and Greece) have been used as transit countries for tramadol destined for North Africa (Egypt and Libya), although some of the tramadol seized in Europe (in particular Sweden) was also intended for the local market. For the first time ever, significant seizures of tramadol were reported in South Asia (India) in 2018, accounting for 21 per cent of the global total that year, which reflects the fact tramadol was put under the control of the Narcotic Drugs and Psychotropic Substances Act of India in April 2018.

As the full-scale scheduling of tramadol in India took place in 2018, and India had been the main source for (illegal) tramadol shipments, the decline in seizures outside India in 2018 may have been the result of a disrupted market. By contrast, and probably as a result of the control in India, seizures of tramadol in that country increased greatly in 2018, and thus in South Asia as a whole (more than 1,000-fold compared with a year earlier).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Ah, bad craziness...a scene like that could run on forever. Sick dialogue comes easy after five months on the campaign trail. A sense of humor is not considered mandatory for those who want to get heavy into presidential politics. Junkies don't laugh much, their gig is too serious - and the political junkie is not much different on that score than a smack junkie.

The high is very real in both worlds, for those who are into it - but anybody who has ever tried to live with a smack junkie will tell you it can't be done without coming to grips with the spike and shooting up yourself.

Politics is no different. There is a fantastic adrenaline high that comes with total involvement in almost any kind of fast-moving political campaign - especially when you're running against big odds and starting to feel like a winner.

As far as I know, I am the only journalist covering the '72 presidential campaign who has done any time on the other side of that gap - both as a candidate and a backroom pol, on the local level - and despite all the obvious differences between running on the Freak Power ticket for sheriff of Aspen and running as a well-behaved Democrat for President of the United States, the roots are surprisingly similar...and whatever real differences exist are hardly worth talking about, compared to the massive, unbridgeable gap between the cranked-up reality of living day after day in the vortex of a rolling campaign - and the fiendish ratbastard tedium of covering that same campaign, as a journalist, from the outside looking in.

For the same reason that nobody who has never come to grips with the spike can ever understand how far away it really is across that gap to the place where the smack junkie lives...there is no way for even the best and most talented journalist to know what is really going on inside a political campaign unless he has been there himself. '

- The Campaign Trail: In the Eye of the Hurricane, July 20, 1972, Fear and Loathing at the Rolling Stone, The Essential Writing of Hunter S. Thompson

'The 2019 drug use survey in India estimated that nearly 1 per cent of the population aged 10–75 had misused pharmaceutical opioids in the past year and that an estimated 0.2 per cent of the population (2.5 million people) were suffering from drug use disorders related to pharmaceutical opioids. Although the breakdown by type of pharmaceutical opioids misused in India is not available, buprenorphine, morphine, pentazocine and tramadol are the most common opioids misused in the country.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'I had 1/16-ounce of junk with me. I figured this was enough to taper off, and I had a reduction schedule carefully worked out. It was supposed to take twelve days. I had the junk in solution, and in another bottle distilled water. Every time I took out a dropper of solution out to use it, I put the same amount of distilled water in the junk solution bottle. Eventually I would be shooting plain water. This method is well known to all junkies. A variaion of it is known as the Chinese cure, which is carried out with hop and Wampole's tonic. After a few weeks, you find yourself drinking plain Wampole's Tonic.

Four days later in Cincinnati, I was out of junk and immoblized. I have never known one of these self-administered reduction cures to work. You find reasons to make each shot an exception that calls for a little extra junk. Finally, the junk is all gone and you still have your habit'

- Junky, William S Burroughs, 1977, originally published in 1953

'The non-medical use of tramadol among other pharmaceutical drugs is reported by several countries in South Asia: Bhutan, India, Nepal and Sri Lanka. In 2017, 130,316 capsules containing tramadol and marketed under the trade name “Spasmo Proxyvon Plus (‘SP+’)” were seized in Bhutan. In Sri Lanka, about 0.2 per cent of the population aged 14 and older are estimated to have misused pharmaceutical drugs in the past year. Among them, the non-medical use of tramadol is the most common, although misuse of morphine, diazepam, flunitrazepam and pregabalin have also been reported in the country. The misuse of more than one pharmaceutical drug (including tramadol) is also a common pattern among heroin users who may use them to potentiate the effects of heroin or compensate for its low level of availability. Recent seizures of tramadol suggest the existence of a market for the drug: in April and September 2018, 200,000 and 1.5 million tablets of tramadol were respectively seized by customs in Sri Lanka.' - United Nations Office on Drugs and Crime, World Drug Report 2020,
https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The trafficking and availability of tramadol for its non-medical use is a public health concern, but limited distribution of tramadol for medical use would also pose a public health concern, in particular in Africa, where there is a chronic shortage of pain medications. There are no data on the availability and use of tramadol for medical purposes, but data on internationally controlled substances clearly highlight the gaps in the accessibility of pain medications. The general lack of access to opioid-related pain medications under international control is a specific problem for developing countries, which is even more pronounced in countries in West and Central Africa than in other parts of the world.

Against this background of a de facto non-availability of internationally controlled opioids for pain medication for large sections of the population in West and Central Africa, tramadol – even though it is under national control in some West African countries – is in fact a widely available opioid in those countries, used for both medical purposes (including outside prescription) and for non-medical purposes' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'About fifteen minutes later the attendant called, "Shot line!" Everyone in the ward lined up. As our names were called, we put an arm through a window in the door of the ward dispensary, and the attendant gave the shots. Sick as I was, the shot fixed me. Right away, I began to get hungry.'

- Junky, William S Burroughs, 1977, originally published in 1953

'In North Africa, tramadol is reported as the main opioid used non-medically in Egypt, where scientific literature about tramadol misuse is more available than elsewhere in the subregion. An estimated 3 per cent of the adult population misused tramadol in 2016, the latest year for which data are available, while 2.2 per cent were diagnosed with tramadol dependence. In drug treatment, tramadol was also the main drug, accounting for 68 per cent of all people treated for drug use disorders in 2017. A cross-sectional study conducted over the period 2012–2013 among 1,135 undergraduate college students in Egypt showed that 20.2 per cent of male and 2.4 per cent of female students had misused tramadol at least once during their lifetime, resulting in an overall lifetime prevalence of 12.3 per cent The average age of initiation of non-medical use of tramadol was around 17 years. Polydrug use was also quite common, with the majority of respondents (85 per cent) reporting use of either tobacco, alcohol or cannabis with tramadol. Among those who had misused tramadol, 30 per cent were assessed to be tramadol dependent.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The non-medical use of tramadol is of particular concern among young people in many countries in that subregion. For example, a cross-sectional study among 300 young people in western Ghana found that while the majority (85 per cent) of respondents knew someone who misused tramadol, more than half of the young people interviewed had used tramadol themselves for non-medical purposes, and one third of the users reported misusing 9–10 doses of tramadol per day. Another qualitative study from Ghana reported curiosity, peer pressure and iatrogenic addiction as the three main factors for initiation and continuing non-medical use of tramadol, while perceived euphoria, attentiveness, relief from pain, physical energy and aphrodisiac effects were mentioned as some of the reasons for continuing non-medical use of tramadol.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The drug use survey in Nigeria reveals tramadol to be a more accessible opioid than heroin, although it is still relatively costly if used frequently. While use of tramadol appears to cost about one third the price of heroin ($3.60 versus $10 per day of use in the past 30 days), in a country where the minimum wage of a full-time worker is around $57 per month, regular tramadol use still poses a considerable financial burden on users and their families. There is no information on the prevalence of drug use in other West African countries, but treatment data reveal tramadol to be the main drug of concern for people with drug use disorders. Tramadol ranks highly among the substances for which people were treated in West Africa in the period 2014–2017. This was particularly the case in Benin, Mali, the Niger, Nigeria, Sierra Leone and Togo.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'At the global level, Germany was the second largest consumer of opioid pain relievers, with an estimated 28,862 S-DDD per million population per day for medical use in 2017, followed by Austria, Belgium and Switzerland. In Germany, the number of pharmaceutical opioids overall and the number of people receiving opioid treatment have increased over the past few decades; in most instances, prescriptions were given for non-chronic cancer pain. A review of scientific literature from Germany published between 1985 and 2016 showed that out of the 12 studies reviewed, 6 studies reported a prevalence for patients with medical use of any opioid for long-term treatment of non-cancer chronic pain ranging from 0.54 to 5.7 per cent, while four studies reported a prevalence for patients with medical use of opioids at 0.057 to 1.39 per cent of the population' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'There were three shots a day. One at seven a.m., when we got up, one at one p.m., and one at nine p.m. Two old acquaintances had come in during the afternoon, Matty and Louis. I ran into Louis as we were lining up for the evening shot.
"Did they get you?" he asked me.
"No. Just here for the cure. How about you?"
"Same with me," he answered.
With the evening shot, they gave me some chloral hydrate in a glass. Five new arrivals were brought to the ward during the night. The ward attendant threw up his hands. "I don't know where I'm going to put them. I've got thirty-one dope fiends in here now."

- Junky, William S Burroughs, 1977, originally published in 1953

'The girl was not interested in whatever reasons I might have for going up to Manchester to spend a few days with the McGovern campaign. She had no plans to vote in any election, for president or anything else.

She tried to be polite, but it was obvious after two or three minutes of noise that she didn't know what the fuck I was talking about, and cared less. It was boring, just another queer hustle in a world full of bummers that will swarm you every time if you don't keep moving.

Like her ex-boyfriend. At first he was only stoned all the time, but now he was shooting smack and acting very crazy. He would call and say he was on his way over, then not show up for three days - and then he'd be out of his head, screaming at her, not making any sense.

It was too much, she said. She loved him, but he seemed to be drifting away. We stopped at a donut shop in Marlborough and I saw she was crying, which made me feel like a monster because I'd been saying some fairly hard things about "junkies" and "loonies" and "doom-freaks."'

- The Campaign Trail: Fear and Loathing in New Hampshire, March 2, 1972, Fear and Loathing at the Rolling Stone, The Essential Writing of Hunter S. Thompson

'The clandestine manufacture of fentanyls within North America is thus not really a new phenomenon and has the potential to increase in importance following the recent control of fentanyls substances in China. Moreover, the clandestine manufacture of fentanyl has already spread beyond North America to neighbouring subregions, as a clandestine fentanyl laboratory was dismantled in the city of Santiago, Dominican Republic, in 2017. At the same time, there is a risk that other countries with a large and thriving pharmaceutical sector may become involved in the clandestine manufacture of fentanyls. In 2018, for example, authorities of India reported two relatively large seizures of fentanyl destined for North America. Furthermore, according to United States authorities, in September 2018, the Directorate of Revenue Intelligence of India, in cooperation with DEA of the United States Department of Justice, dismantled the first known illicit fentanyl laboratory in India and seized approximately 11 kg of fentanyl' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'According to United States authorities, most of the fentanyls destined for the North American market have been manufactured in China in recent years, from where they were either shipped directly to the United States, mostly through postal services, or were first shipped to Mexico and, to a lesser extent, Canada and then smuggled into the United States. However, after the introduction by China in May 2019 of drug controls based on generic legislation with regard to the fentanyls, which effectively brought more than 1,400 known fentanyl analogues under national control in China, early signs suggest that fewer fentanyls were smuggled from China to North America. At the same time, attempts to manufacture fentanyl and its analogues inside North America are increasing, notably in Mexico, by means of a method using precursor chemicals smuggled into the subregion from East Asia and South Asia.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The current crisis of fentanyls appears to be more supply-driven than earlier waves of increases in the use of pharmaceutical opioids or heroin. Fentanyls are being used as an adulterant of heroin, are used to make falsified pharmaceutical opioids, such as falsified oxycodone and hydrocodone – and even falsified benzodiazepines – which are sold to a large and unsuspecting population of users of opioids and other drugs; users are not seeking fentanyl as such.

It seems that some local distributors are not able to distinguish between heroin, fentanyl and fentanyl laced heroin, nor between diverted pharmaceutical opioids and falsified opioids containing fentanyl. A general problem with fentanyls is dosing by nonprofessional “pharmacists”, where small mistakes can lead to lethal results. Furthermore, as the overdose death data suggest, even people using cocaine and psychostimulants, such as methamphetamine, are also exposed – probably unintentionally – to fentanyls or other potent synthetic opioids mixed with those substances' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The cure at Lexington is not designed to keep the addicts comfortable. It starts at one-quarter of a grain of M[orphine] three times a day and lasts eight days-the preparation now used is a synthetic morphine called dolophine. After eight days, you get a send-off shot and go over in "population." There you recieve barbiturates for three nights and that is the end of medication.
For a man with a heavy habit, this is a very rough schedule. I was lucky, in that I came in sick, so the amount given in the cure was sufficient to fix me. The sicker you are and the longer you have been without junk, the smaller the amount necessary to fix you.'

- Junky, William S Burroughs, 1977, originally published in 1953

'There is a great incentive for trafficking organizations to expand the fentanyl market: the large associated revenues. Compared with heroin, the production costs of single-dose fentanyls are substantially lower. For instance, it may cost between $1,400 and $3,500 to synthesize 1 kg of fentanyl, which could bring a return of between $1 million and $1.5 million from street sales. For comparison, 1 kg of heroin purchased from Colombia may cost $5,000 to $7,000,99 around $53,000 at the wholesale level in the United States and around $400,000 at the retail level in the United States. With fentanyls, the logistics for supply are also more flexible because fentanyls can be manufactured anywhere and are not subject to the climatic conditions or the vulnerable conditions required for the largescale cultivation of opium poppy.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'All factors driving fentanyl use converged from 2013 onwards in the United States and Canada, which may explain the unprecedented spread of the fentanyls in those markets: factors such as the diffusion of simpler, more effective methods of manufacture of synthetic opioids and their analogues (primarily fentanyls), assisted by the availability on the Internet of instructions for their manufacture; a shift from preparation by a limited number of skilled chemists to preparation by basic “cooks” who could simply follow the posted instructions; the discovery of ever more fentanyl analogues; a lack of effective control of precursors and oversight of the industry; expanding distribution networks that reduced the risk of detection through the use of postal services and the Internet; and increased licit trade including e-commerce.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In 2018, approximately 10.3 million people (3.7 per cent of the population aged 12 years or older) had misused opioids in the past year in the United States. Most of them, 9.9 million (3.6 per cent of the population aged 12 years and older), reported non-medical use of pharmaceutical opioids, while almost 800,000 reported past-year use of heroin (comprising just 8 per cent of the total population who reported past-year misuse of opioids).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Overall, in 2018 overdose deaths attributed to synthetic opioids, comprising mainly fentanyls, accounted for nearly half of the total overdose deaths in the United States. Among the reasons for the high number of overdose deaths attributed to fentanyls are their often small lethal doses relative to other opioids: fentanyl, for example, is approximately 100 times more potent than morphine, and carfentanil may be as much as 10,000 times more potent than morphine for an average user. A lethal dose of carfentanil for a human can be as low as 20 micrograms.

The rapid expansion of fentanyl use in the United States is also visible in the data on seizures and the drug samples analysed, with a considerable increase since 2014 in the number of samples identified as fentanyl. In 2018, fentanyl accounted for 45 per cent of the pharmaceutical opioids that were identified in different samples, while oxycodone accounted for 14 per cent' - United Nations Office on Drugs and Crime, World Drug Report 2020,
https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The rate of prescription of opioids in the United States fell to 51.4 prescriptions per 100 persons (a total of more than 168 million opioid prescriptions) in 2018 from a peak of 81.3 opioid prescriptions per 100 persons (or 255 million opioid prescriptions) in 2012. The opioid prescription rate in the southern United States remains high, however, with most states in the region reporting opioid prescription rates of 64 or more per 100 persons in 2018. A number of factors at work, including advertising by the pharmaceutical industry, physicians’ prescription practices, dispensing and medical culture and patient expectations have, since the new millennium, resulted in high prescription rates and dosages of opioids given for an extended duration of care, primarily for the management of acute to chronic non-cancer pain. These practices have also enabled the diversion and misuse of pharmaceutical opioids, together with a greater risk of opioid use disorders among those with a legitimate prescription.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The dolophine suspends the sickness, but when the medication stops the sickness returns. "You don't kick your habit in the shooting gallery," an inmate told me. "You kick it over here in population."

- Junky, William S Burroughs, 1977, originally published in 1953

'The scientific literature has attempted to understand the reasons for the sudden rise of fentanyls in preexisting opioid markets. It seems that an interplay between a number of external factors and local market dynamics played a role in the spread of the opioid crisis in North America. Some of the factors that have led to the rise and continued presence of fentanyls include: (a) the diffusion of simpler and more effective methods of manufacture of synthetic opioids and their analogues (primarily fentanyls); (b) a lack of effective control of precursors and oversight of the manufacture industry; (c) expanding distribution networks; (d) reduced smuggling risks because of new methods of trafficking within the expanded licit trade; and (e) pre-existing market conditions (demand for opioids and potential supply shocks)' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Although geographically disconnected, the areas that were initially affected by the opioid crisis in Canada and the United States have experienced remarkably similar market dynamics, which can be broadly described in the following sequential steps: (a) High rates of prescriptions for pharmaceutical opioids leading to diversion and an increase in the non-medical use of pharmaceutical opioids, opioid use disorders and an increase in opioid overdose deaths (b) Regulations introduced to reduce diversion and non-medical use of pharmaceutical opioids (e.g., tamper-proof formulations to prevent injecting) (d) Fentanyl (illicitly manufactured in clandestine laboratories) and its analogues emerge as adulterants in heroin and stimulants (cocaine and methamphetamine) and are sold as falsified pharmaceutical opioids, resulting in massive increases in deaths attributed to fentanyls (e) Fentanyls emerge as the dominant opioid in opioid overdose deaths, as well as contributing to overdose deaths attributed to other drugs (g) Fentanyl-related deaths are the main contributor to total opioid overdose deaths;' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In other words, the weight of the evidence filtering down from the high brainrooms of both the New York Times, and the Washington Post seems to say we're all fucked. Muskie is a bonehead who steals his best lines from old Nixon speeches. McGovern is doomed because everybody who knows him has so much respect for the man that they can't bring themselves to degrade the poor bastard by making him run for president...John Lindsay is a dunce, Gene McCarthy is crazy, Humphrey is doomed and useless, Jackson should have stayed in bed...and, well, that just about wraps up the trip, right?

Not entirely, but I feel The Fear coming on, and the only cure for that is to chew up a fat black wad of blood-opium about the size of a young meatball and then call a cab for a fast run down to that strip of X-film houses on 14th Street...peel back the brain, let the opium take hold, and get locked into serious pornography.

As for politics, I think Art Buchwald said it all last month in his "Fan letter to Nixon."

"I always wanted to get into politics, but I was never light enough to make the team."

- The Campaign Trail: The Million-Pound Shithammer, February 3, 1972, Fear and Loathing at the Rolling Stone, The Essential Writing of Hunter S. Thompson

'From what is known, it is possible to identify common threats and different dynamics in the two opioid crises, in Africa and in North America: • The ease of manufacturing, easy accessibility and low-cost production make the illicit markets for tramadol and fentanyls substantially more profitable for traffickers than are other opioids such as heroin. • The large-scale manufacture of tramadol and fentanyls for the illicit market started in a context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. • The interchangeability (or substitution) of fentanyl and tramadol within the pharmaceutical and illicit drug markets makes it more difficult to address their misuse. Their non-medical use is also seen in the context of self-medication, and thus carries less stigma or is countered by lesser legal sanctions than is the case with other controlled drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'There was a raw ache in my lungs. People vary in the way junk sickness affects them. Some suffer mostly from vomitting and diarrhea. The asthmatic type, with narrow and deep chest, is liable to violent fits of sneezing, watering at eyes and nose, in some cases spasms of the bronchial tubes that shut off the breathing. In my case, the worst thing is lowering of blood pressure with consequent loss of body fluid, and extreme weakness, as in shock. It is a feeling as if the life energy has been shut off so that all the cells in the body are suffocating. As I lay there on the bench, I felt like as if I was subsiding into a pile of bones.'

- Junky, William S Burroughs, 1977, originally published in 1953

'In West, Central and North Africa and the Middle East, tramadol – a pharmaceutical opioid not under international control – has emerged as a major opioid of concern. The drug, in addition to being diverted from the legal market, is mainly trafficked into those subregions in dosages higher than what is prescribed for pain management, with an increasing number of people with tramadol use disorder entering treatment.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The non-medical use of pharmaceutical opioids is not a new phenomenon. It has been observed for decades as part of the polydrug use pattern among high-risk or regular opioid users. What characterizes the most recent opioid crisis is the emergence of non-medical use of pharmaceutical opioids as the main phenomenon, leading to alarming rates of dependence and overdose deaths at the national level. The subregions most affected by this crisis are North America and West, Central and North Africa, where different opioids and different dynamics are driving the threat. In North America, the introduction of fentanyl and its analogues (fentanyls) in the drug market has resulted in a epidemic of use of opioids characterized by an unprecedented increase in opioid overdose deaths' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In the context of the long-term dynamics of the global drug market, there are many different changes that have affected selected geographical areas. Within the past two decades some regions have seen a gradual transformation of their drug markets: methamphetamine has become the predominant drug in South-East Asia, amphetamine (“captagon’’) in the Middle East, North America has been confronted with the opioid crisis, Africa has seen an expansion of its domestic heroin market, and countries in North and West Africa are now facing a tramadol crisis. More recently, two subregions, the Near and Middle East/South-West Asia and the Russian Federation/ Central Asia, appear to have been affected by rapid changes in their drug markets, with new drugs taking a substantial share of the drug market.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Although in Europe opioids continue to be the predominant main drug for which people seek drug treatment, cocaine has become more common in Spain and methamphetamine remains the main drug of concern in Czechia. Within the amphetamines group, different patterns have developed in different subregions. For example, amphetamine continues to be the primary ATS of concern in Europe and in the Middle East, while methamphetamine has emerged as the primary ATS of concern in East and South-East Asia and in North America.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'The doctor asked a few questions and looked at my arms. Another doctor with a long nose and hairy arms walked up to put in his two cents.
"After all, doctor," he said to his colleague, "there is the moral question. This man should have thought of all this before he started using narcotics."
"Yes, there is the moral question, but there is also a physical question. This man is sick." He turned to a nurse and ordered half a grain of morphine.
As the wagon jolted along on the way back to the precinct, I felt the morphine spread through all my cells. My stomach moved and rumbled. A shot when you are very sick always starts the stomach moving. Normal strength came back to all my muscles. I was hungry and sleepy.'

- Junky, William S Burroughs, 1977, originally published in 1953

'While the main drug treatment interventions in Asia and Europe continue to be linked primarily to opiates, in Africa to cannabis, and in South America to cocaine, in North America there has been a shift over the past decade from the predominance of cocaine to an increasing importance of opioids. Marked shifts in the main drug for which patients receive drug treatment can also been observed at the subregional level. In a number of countries in East and South-East Asia, for example, methamphetamine has emerged as the predominant drug; in the Near and Middle East, “captagon” tablets (amphetamine), and along the eastern coast of Africa, heroin, have emerged as the predominant drugs.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Increases in drug use have at times also been supply driven, as users react to growing supply and the attendant falling prices by increasing their consumption of those drugs. This was the case with cocaine in recent years, among other drugs. Some of the recent changes in drug markets, such as the opioid crisis in North America and the rapid emergence of a synthetic drug market in the Russian Federation and Central Asia, can also be defined as supply driven phenomena. The expansion of the synthetic drugs market in the Russian Federation seems to be mainly linked to the Hydra darknet platform. While there may now be an established user-based demand for synthetic drugs, the initial trigger was new suppliers. The rise of fentanyl in North America was not defined by a new demand either but was the result of opportunities seized by drug suppliers to reduce costs and thus increase profit margins.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'Demand-driven dynamics of drug markets are the result of changing patterns of drug use and the desire of users to experiment with new substances, which may lead to an increasing number of users starting a new habit. The establishment of the tramadol market for recreational use in certain regions may have initially been generated by an increased demand based on the supply available for medical use. But once a demand was generated, a new supply-driven phenomenon further expanded the market with illicitly manufactured products that were not part of the medical market' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'He reported that the patient's pain scores decreased from 8 out of 10 on the visual analog scale to 2 out of 10 following cannabis initiation. During this time, the patient also was able to "completely wean off her opioid narcotics and reported no side effects." The patient was confirmed by a drug test to still be opioid-free after six-months. The patient had previously been prescribed opioids for pain relief for a period of several years'
https://norml.org/news/2020/03/26/case-report-chronic-pain-patient-weaned-off-opioids-following-cannabis-therapy

'The opioid epidemic has had three phases: the first was dominated by prescription opioids, the second by heroin, and the third by cheaper — but more potent — synthetic opioids such as fentanyl. All of these forms of opioid remain relevant to the current crisis. “Basically, we have three epidemics on top of each other,” Humphreys says. “There are plenty of people using all three drugs. And there are plenty of people who start on one and die on another.”'
https://www.nature.com/articles/d41586-019-02686-2

'A few minutes later a nurse came in with a hypo. It was demerol. Demerol helps some, but it is not nearly as effective as codeine in relieving junk sickness.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Cultural differences between Europe and North America probably also contribute to the regions’ differing fortunes with opioids. Large-scale surveys show that there is a similar prevalence of pain in France and Italy as there is in the United States. But according to data from the United Nations, US doctors write five and a half times more prescriptions for opioids than do their counterparts in France, and eight times more than do physicians in Italy. Humphreys says that this might be because people in the United States expect to receive a prescription when they go to the doctor with a health concern. Meanwhile, direct advertising of pharmaceuticals to consumers (permitted only in the United States and New Zealand) encourages them to ask doctors for specific drugs.'
https://www.nature.com/articles/d41586-019-02686-2

In 2013, between 28 and 38 million people used opioids illicitly (0.6% to 0.8% of the global population between the ages of 15 and 65). As of 2015, increased rates of recreational use and addiction are attributed to over-prescription of opioid medications and inexpensive illicit heroin. 69,000 people worldwide die of opioid overdose each year and 15 million people have an opioid addiction. Research suggests that when methadone is used long-term it can build up unpredictably in the body and lead to potentially deadly slowed breathing. Used medically, approaching toxicity goes unrecognized because the pain medication effect ends long before the drug's elimination half-life. According to the USCDC, methadone was involved in 31% of opioid related deaths in the US between 1999–2010 and 40% as the sole drug involved, far higher than other opioids. Respiratory depression is the most serious adverse reaction associated with opioid use, but it usually is seen with the use of a single, intravenous dose in an opioid-naïve patient. In patients taking opioids regularly for pain relief, tolerance to respiratory depression occurs rapidly, so that it is not a clinical problem. - https://en.wikipedia.org/wiki/Opioid.

See any similarities with countries with high COVID fatality count?

'In 2018, most of the consumption of fentanyl (81.7 per cent) was concentrated in 10 countries, all of which were high-income countries. The three largest consumers of fentanyl were the United States (accounting for 20.8 per cent of global consumption, or 307.9 kg), Germany (17.6 per cent, or 259.4 kg) and the United Kingdom (15.6 per cent, or 230.6 kg). Other major consumers of fentanyl were, in descending order of the amounts consumed, Spain, Italy, France, the Netherlands, Canada, Australia and Belgium.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, world exports of codeine increased to 158.8 tons, compared with 139.2 tons in 2017, almost reaching the peak of 176.5 tons recorded in 2012 (see figure 16), and the United Kingdom became, for the first time, the main country exporting codeine (accounting for 35.2 tons, or 22.2 per cent of the global exports). It was followed by France (30.5 tons, or 19.2 per cent), Australia (29.5 tons, or 18.6 per cent), Norway (15.8 tons, or 9.9 per cent), the Islamic Republic of Iran (10.4 tons, or 6.6 per cent), Spain (6.6 tons, or 4.2 per cent), Italy (6.6 tons, or 4.1 per cent), Switzerland (5.9 tons, or 3.7 per cent), Slovakia (4.4 tons, or 2.8 per cent) and Hungary (3.9 tons, or 2.5 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

Legalize cannabis globally for pain and inflammation management so that it can be home grown by any one making it accessible and affordable to all...

'In 2018, 79 per cent of the world population, mainly persons in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering. Although the situation improved in the previous 20 years, the disparity in consumption of narcotic drugs for palliative care continues to be a matter of concern, particularly in relation to access and availability of affordable opioid analgesics such as morphine. The remaining 87 per cent of the total consumption of morphine, excluding preparations in Schedule III of the 1961 Convention, continued to be concentrated in a small number of countries, mainly in Europe and North America. In 2018, European countries as a whole and the United States accounted for the highest share of global morphine consumption (39.5 per cent and 39.3 per cent respectively); they were followed by Canada (5.1 per cent), Australia and New Zealand (2.5 per cent) and Japan (0.6 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

- Junky, William S Burroughs, 1977, originally published in 1953

Legalize cannabis globally for pain and inflammation management so that it can be home grown by any one making it accessible and affordable to all...

'In 2018, 79 per cent of the world’s population, mainly people in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering, or 1 per cent of the 388.2 tons of morphine manufactured world-wide. Although that was an improvement over 2014, when 80 per cent of the world’s population consumed only 9.5 per cent of the morphine used for the management of pain and suffering, the disparity in the consumption of narcotic drugs for palliative care continues to be a matter of concern'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'About 70 percent of morphine is used to make other opioids such as hydromorphone, oxymorphone, and heroin. Potentially serious side effects include decreased respiratory effort and low blood pressure. Morphine is addictive and prone to abuse. A large overdose can cause asphyxia and death by respiratory depression if the person does not receive medical attention immediately. One poor quality study on morphine overdoses among soldiers reported that the fatal dose was 0.78 mcg/ml in males (~71 mg for an average 90 kg adult man) and 0.98mcg/ml in females (~74 mg for an average 75 kg female). It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. According to a 2005 estimate by the International Narcotics Control Board, six countries (Australia, Canada, France, Germany, the United Kingdom, and the United States) consume 79% of the world's morphine. The less affluent countries, accounting for 80% of the world's population, consumed only about 6% of the global morphine supply'
https://en.wikipedia.org/wiki/Morphine

'Codeine is an opiate used to treat pain, coughing, and diarrhea. Serious side effects may include breathing difficulties and addiction. A potentially serious adverse drug reaction, as with other opioids, is respiratory depression. This depression is dose-related and is a mechanism for the potentially fatal consequences of overdose. Codeine works following being broken down by the liver into morphine; how quickly this occurs depends on a person's genetics. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.'
https://en.wikipedia.org/wiki/Codeine

'Codeine is the most commonly used opioid in the world. Regulation of its availability varies among countries; in New Zealand, the United Kingdom, most of Canada, and Ireland, codeine is available as an over-the-counter (OTC) preparation and is often combined with paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. Despite its wide use, there are a number of concerns about codeine as an analgesic, with risks of prolonged misuse of OTC codeine-ibuprofen products including life-threatening complications such as gastric bleeds, renal failure, hypokalemia, and opioid dependence.

In addition to risk of serious harm, there is limited evidence for the addition of low-dose codeine (16 to 25 mg of codeine per dose) to paracetamol or ibuprofen preparations for improved pain relief. This, coupled with the known availability of effective nonopioid alternatives for pain relief, raises concerns about the place of low-dose codeine in ongoing pain management.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101496/

'When my wife came to see me later in the day, she told me they were using a new treatment in my case. The treatment had started with my morning shot.
"I noticed a difference. I thought the morning shot was M[orphine]."
"I talked with Dr. Moore on the phone. He told me that this is the wonder drug they have been looking for to treat drug addiction. It relieves withdrawal symptoms without forming a new habit. It isn't a narcotic at all. It is one of the antihistamines. Thephorin, I believe he said."
"Then it would seem withdrawal symptoms are an allergic reaction."
"That's what Dr. Moore says."

- Junky, William S Burroughs, 1977, originally published in 1953

Legalize the ganja worldwide as a harm reduction strategy...

'Results
The open-web crawling/navigating software identified some 426 opioids, including 234 fentanyl analogs. Of these, 176 substances (162 were very potent fentanyls, including two ohmefentanyl and seven carfentanyl analogs) were not listed in either international or European NPS databases.

Conclusion
A web crawling approach helped in identifying a large number, indeed higher than that listed by European/international agencies, of unknown opioids likely to possess a significant misuse potential. Most of these novel/emerging substances are still relatively unknown. This is a reason of concern; each of these analogs potentially presents with different toxicodynamic profiles, and there is a lack of docking, preclinical, and clinical observations. Strengthening multidisciplinary collaboration between clinicians and bioinformatics may prove useful in better assessing public health risks associated with opioids'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093327/

'llicitly manufactured fentanyl and its analogues are involved in large numbers of deaths in some countries, such as Estonia, and Sweden which saw a peak in 2017. In England, in the spring of 2017, intelligence from post-mortem results and drug seizures suggested that fentanyl and its analogues had been introduced into the heroin supply in the north of the country. Public Health England issued an alert at the end of April 2017 advising (1) on the availability of, and harms from, heroin that had been mixed with fentanyl or carfentanil, (2) that warnings be cascaded and (3) of the naloxone dosing regime in the event of an overdose.

It is very important to follow closely any signal and alert about harms related to fentanyl and fentanyl analogues, because these substances have a very high toxicity, compared to other opioids, namely heroin. They have therefore the potential to create large clusters of incidents and of deaths if they enter the drug markets in Europe.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#section4

'Opioids, mainly heroin or its metabolites, often in combination with other substances, are present in the majority of fatal overdoses reported in Europe. In most drug-related deaths, more than one substance is detected, indicating polydrug use.

Overall, opioids are involved in 77.8 % of cases, with large differences across countries (see more country-level data in the Statistical Bulletin).'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#question11

'An update from the EMCDDA expert network, published in July 2019, also highlighted that opioids, often heroin, are involved in between 8 and 9 out of every 10 drug-induced deaths reported in Europe, although this is not true for all countries. Opioids used in substitution treatment can also be found in post-mortem analyses in some countries. Deaths related to medications, such as oxycodone and tramadol, are also reported. Deaths associated with fentanyl and its analogues are probably underestimated, and outbreaks of deaths related to these substances have been reported'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en

'I was too weak to get out of bed. I could not lie still. In junk sickness, any conceivable line of action or inaction seems intolerable. A man might simply die because he could not stand to stay in his body.'

- Junky, William S Burroughs, 1977, originally published in 1953

'We found that heroin use is not simply an inner-city problem among minority populations but now extends to white, middle-class people living outside of large urban areas, and these recent users exhibit the same drug use patterns as those abusing prescription opioids. In this connection, our data indicate that many heroin users transitioned from prescription opioids. The factors driving this shift may be related to the fact that heroin is cheaper and more accessible than prescription opioids, and there seems to be widespread acceptance of heroin use among those who abuse opioid products.'
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575

'Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose, and marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic.'
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2677000

'Then fentanyl hit the streets. A synthetic opioid developed in 1960 by a Belgian physician, fentanyl is normally reserved for surgery and cancer patients. It is up to 100 times more powerful than morphine, its chemical cousin.

For traffickers, illicit fentanyl produced in labs was the most lucrative opportunity yet, a chance to bypass the unpredictability of the poppy fields that produced their heroin. The traffickers could order one of the cheapest and most powerful opioids on the planet directly from Chinese labs over the Internet.

It was 20 times more profitable than heroin by weight. By lacing a little of the white powdery drug into their heroin, the dealers could make their product more potent and more compelling to users. They called it China White, China Girl, Apache, Dance Fever, Goodfella, Murder 8 or Tango & Cash.'
https://www.washingtonpost.com/graphics/2019/national/fentanyl-epidemic-obama-administration/

'This study investigates prior prescription opioid misuse in a cohort of heroin users whose progress was tracked in a treatment study conducted in the US from 2006 to 2010. Half of the sample misused prescription opioids (“other opiates/analgesics”) prior to their onset of heroin misuse (POBs). We found that POBs were demographically younger and more likely to be white than other heroin users (OHUs). There were differences between the two groups with respect to the reporting of at least one year of regular use of substances and age of onset of substance use. POBs were more likely to report regular use, and earlier onset of use of several substances, mostly of the type potentially obtained via prescription. POBs were more persistent in their opioid use and more likely to suffer near-term elevated depressive symptoms compared with OHUs. These findings suggest that heroin addiction treatment may need to be tailored according to opioid misuse history.'
https://www.sciencedirect.com/science/article/pii/S2352853218300117

'He asked the question they all ask. "Why do you feel that you need narcotics, Mr Lee?"
When you hear this question you can be sure that the man who asks it knows nothing about junk.
"I need it to get out of bed in the morning, to shave and eat breakfast."
"I mean physically."
I shrugged. Might as well give him his diagnosis so he will go. "It's a good kick."
Junk is not a "good kick." The point of junk to a user is that it forms a habit. No one knows what junk is until he is junk sick.
The doctor nodded. Psychopathic personality.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Fentanyl, a drug more potent that heroin, is the latest iteration of America's evolving opioid epidemic.'

https://www.youtube.com/watch?v=BXmyPsqkP44

Legalize marijuana...

'Fentanyl, the synthetic opioid about 50 times stronger than heroin, has ravaged communities across the nation. In places like Philadelphia, the problem is only getting worse. Reporter Wesley Lowery investigates.'
https://www.youtube.com/watch?v=88lo6U4OiQ8

'By 2013, over 1,000 Americans were treated daily in emergency departments for prescription opioid misuse and in 2014, 4.3 million people used prescription opioids for non-medical reasons. This trend was also seen in the number of deaths attributed to oxycodone, which increased from 14 cases in 1998 to ~14,000 cases in 2006 and 18,000 in 2015. Although not of the same magnitude and somewhat delayed, this increase in opioid abuse and mortality is also occurring in other countries. In Australia, oxycodone-related deaths increased sevenfold between 2001 and 2011. In Finland, opioid mortalities increased from 9.5% of all drug overdose deaths in 2000 to 32.4% in 2008, and data from Brazil, China, and the Middle East show similar increases in opioid diversion. In the United Kingdom, although tramadol and methadone are misused over oxycodone, the pattern of opioid misuse shows a similar increase to the USA albeit on a smaller scale. While Americans consume 80% of the global opioid supply and 99% of the global hydrocodone supply and the number of overdose mortalities is considerably higher in the USA, the opioid epidemic is growing worldwide.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925443/

'Not long ago, Stanford psychiatrist Anna Lembke would refuse to treat anyone who used opioids, believing that there wasn’t much she could do until they stopped abusing the addictive painkiller. Since researching and writing her new book, “Drug Dealer, M.D.,” she has come to a very different way of thinking and understanding of how doctors themselves have been acting as drug dealers.'
https://www.youtube.com/watch?v=AsbJGfK0evk

'The study, conducted by researchers at the Johns Hopkins University School of Medicine and published in the forthcoming issue of the Journal of Substance Abuse Treatment, asked 200 people with past-month opioid and marijuana use whether their symptoms of opioid withdrawal improved or worsened when they consumed cannabis.

Of the 125 respondents who used marijuana to treat their withdrawal, nearly three-quarters (72 percent) said it eased their symptoms, while only 6.4 percent said it made them worse. Another 20 percent reported mixed results, and three people (2.4 percent) said cannabis didn’t seem to have an obvious effect either way.'
https://www.marijuanamoment.net/cannabis-may-ease-opioid-withdrawal-symptoms-johns-hopkins-study-finds/

Hey junkie, this dope is not against you. Of course he believes that his dope is a much better intoxicant, more versatile medicine and more useful to the planet than your junk is but that doesn't mean he intends to ban your junk in retribution for you helping to get his dope banned. What he does want, however, is that you start growing your own plant at home like him. In this way, you source your junk directly from the plant instead of putting money in the pockets of chemists who increasingly make more and more toxic stuff that destroy you, me and the planet. Your money is making the chemist pay the government to arm itself and protect him while pushing you and me closer to death. Growing your own plant will give you organic healthy junk in the best possible way, directly from the plant, like how it used to be for thousands of years, making you sustainable and the planet sustainable..yes, you can go green too..don't remain snowblind..we need your eyes too, to steer the planet away from man-made chemical disaster...
May 1, 2020, 6:56 PM

'Access to cannabis reduces pain patients' perceived demand for opioids, according to data published in the Journal of Psychopharmacology.

A team of investigators affiliated with the John Hopkins School of Medicine assessed whether or not cannabis availability would hypothetically influence pain patients' demand for prescription opioids. One hundred and fifty-five subjects with recent experience using both opioids and cannabis for pain management participated in the survey.'
https://norml.org/news/2020/04/30/study-suggests-that-cannabis-access-reduces-opioid-demand-among-pain-patients

Hey junkies, if you love your drug so much why don't you direct some positive energy towards legalizing the opium plant for recreational use? This will make the world more sustainable. It will break the stranglehold that pharmaceutical companies, medical officials, law enforcement, drug cartels and governments have over the world. It will counteract the ever increasing potency of opioid drugs, the shift to more dangerous and synthetic versions of it, the adulteration and the increasing deaths. Your synthetic chemical habit has resulted in the world getting locked down and billions feeling the pain of your habit. Get your plant legalized, grow it at home, become sustainable and save the world. Cut out the dependencies on the supply chain and the approvals from doctors and harassment from law enforcement. I'm sure there's enough of you around to make this happen..a lot of you must be the top businessmen, heads of government, law enforcement heads, leading health officials, etc. You should unite to make the opium plant legal as well besides the divine herb..its time for back to nature, sustainable, pro-majority, truly global initiatives and to stop this living in a opium haze while the world dies...
May 3, 2020, 9:26 PM

The number of methadone maintenance treatment clinics is an indication of the extent of opioid addiction...

'Researchers concluded: "In this study, we observed dynamic changes in opioid distribution for eleven opioids used for pain and OUD [opioid use disorder] within Colorado, and two carefully selected comparison states, Utah and Maryland, from 2007 to 2017. Colorado, after legalizing recreational marijuana, had a significant decrease in prescription opioids distributed for pain. The findings from this geographically limited study were challenging to interpret because, while analgesic opioid use was unchanged in Utah, Maryland also had a significant decline [though this decline was not as significant as was observed in Colorado.] Other national research more clearly showed that marijuana policies were associated with reductions in analgesic opioid use. This appears to be an empirically informed public policy strategy which may contribute to reversing the US opioid epidemic."'

Take the Liu Jiao Ting MMT clinic as an example, the clinic is located in central area of the COVID-19 epidemic (close to the Hua Nan Seafood Market) in Wuhan, serving 300 MMT patients living in the surrounding communities. The average number of visits decreased from 127 persons per day to 109 persons per day. We just finished a small survey using PHQ-9 and GAD-7 for 17 clients. Participants experienced some level of depression (PHQ mean score 14.65±5.37) and anxiety (GAD mean score 11.65±4.14). 14 participants reported it was difficulty to go to the clinic for medication, and 2 participants reported having been exposed to COVID-19 patients, while luckily no patients have been infected so far. The situation of the other 11 MMT clinics in Wuhan is very similar to that in Liu Jiao Ting clinic'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152875/

'After a junk cure is complete, you generally feel fine for a few days. You can drink, you can feel hunger and pleasure in food, and your sex drive comes back on you. Everything looks different, sharper. Then you hit a sag. It is an effort to dress, get out of a chair, pick up a fork. You don't want to do anything or go anywhere. You don't even want junk. The junk craving is gone, but there isn't anything else. You have to sit this period out. Or work it out. Farm work is the best cure.'

- Junky, William S Burroughs, 1977, originally published in 1953

Methadone, buprenorphine and naloxone are also opioids..they are used in treatment of abuse of other opioids like heroin, oxycodone, morphine, codeine, fentanyl, hydrocodone...they are also dangerous and addictive..basically an approach of fighting fire with fire...obviously the underlying crisis which needs to be addressed is the opioid abuse crisis

'Fourthly, there is no clarity regarding the running of opioid substitution treatment centres. In response to the unforeseen circumstances, flexible dosing of buprenorphine (take home doses for 1–2 weeks) and methadone (biweekly refill, in some exceptional cases for 5 days) has been suggested (personal communication with National Drug Dependence Treatment Centre, March 25, 2020). This will help in improving their treatment compliance as well reduce the number of visits during the lockdown. However, since the introduction of methadone in 2015 in India, there is no experience with take home or flexible doses (Ambekar et al., 2018). COVID-19 spread and the associated lockdown can give rise to psychological distress in patients with SUDs, who in turn are likely to take higher doses of methadone available to them as a coping strategy. Thus, there are chances that patients may overdose or mix several drugs available to them. The situation gets further complicated as naloxone is scarcely available and there is no provision of take home naloxone in India'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194862/

The global opioid crisis, deep rooted and increasingly pervasive, hides behind the mask of the coronavirus...legalize the ganja globally to counter the underlying disease of opioid addiction and its fatalities..
May 6, 2020, 5:42 PM

'Researchers concluded: "In this study, we observed dynamic changes in opioid distribution for eleven opioids used for pain and OUD [opioid use disorder] within Colorado, and two carefully selected comparison states, Utah and Maryland, from 2007 to 2017. Colorado, after legalizing recreational marijuana, had a significant decrease in prescription opioids distributed for pain. The findings from this geographically limited study were challenging to interpret because, while analgesic opioid use was unchanged in Utah, Maryland also had a significant decline [though this decline was not as significant as was observed in Colorado.] Other national research more clearly showed that marijuana policies were associated with reductions in analgesic opioid use. This appears to be an empirically informed public policy strategy which may contribute to reversing the US opioid epidemic."'
https://norml.org/news/2020/05/21/study-prescription-opioid-distribution-falls-following-adult-use-marijuana-legalization

'ICU patients frequently receive opioid and benzodiazepine medications to treat the pain, anxiety, and agitation experienced during a critical illness. Trauma ICU (TICU) patients may require high and/or prolonged doses of opioids to manage pain associated with multiple open wounds, fractures, painful procedures, and/or surgery. They may also require benzodiazepines to prevent or manage anxiety and agitation and to facilitate effective mechanical ventilation (MV).

Although the effect of different pain and sedative medication regimens on TICU patients is unclear, prior evidence suggests that administration of opioid and benzodiazepine medications in the ICU setting is associated with the development of many complications including delirium and poor patient outcomes (e.g. longer days spent on MV and longer ICU and hospital stays). Exposure to high or prolonged use of opioids and benzodiazepines may also contribute to both drug tolerance (increased dose of medication is required to maintain the same effect) and drug physical dependence (abrupt or gradual drug withdrawal causes unpleasant physical symptoms). Once drug dependence has developed, patients are then at risk for withdrawal syndrome (WS), a group of serious physical and psychologic symptoms that occur upon the abrupt discontinuation of these medications. The effect of WS on patient recovery and prolonged ICU stay is unclear.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188437/

'Cannabis has been used to relieve the symptoms of disease for thousands of years. However, social and political biases have limited effective interrogation of the potential benefits of cannabis and polarised public opinion. Further, the medicinal and clinical utility of cannabis is limited by the psychotropic side effects of ?9-tetrahydrocannabinol (?9-THC). Evidence is emerging for the therapeutic benefits of cannabis in the treatment of neurological and neurodegenerative diseases, with potential efficacy as an analgesic and antiemetic for the management of cancer-related pain and treatment-related nausea and vomiting, respectively. An increasing number of preclinical studies have established that ?9-THC can inhibit the growth and proliferation of cancerous cells through the modulation of cannabinoid receptors (CB1R and CB2R), but clinical confirmation remains lacking. In parallel, the anti-cancer properties of non-THC cannabinoids, such as cannabidiol (CBD), are linked to the modulation of non-CB1R/CB2R G-protein-coupled receptors, neurotransmitter receptors, and ligand-regulated transcription factors, which together modulate oncogenic signalling and redox homeostasis. Additional evidence has also demonstrated the anti-inflammatory properties of cannabinoids, and this may prove relevant in the context of peritumoural oedema and the tumour immune microenvironment. This review aims to document the emerging mechanisms of anti-cancer actions of non-THC cannabinoids.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226605/

'When a junkie off junk gets drunk to a certain point, his thoughts turn to junk.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Case Series : Except for one patient, all of them presented with a typical initial opioid toxidrome consisting of central nervous system and respiratory depression along with pinpoint pupils. Naloxone was given to them, triggering severe agitation and combative behavior along with overlapping features of anticholinergic and sympathomimetic toxidrome. All patients required multiple doses of benzodiazepines. Three were successfully treated with physostigmine.

Discussion: 5F-MDMB-PINACA is a synthetic cannabinoid that was added to heroin in samples obtained from patients reported in this case series. Patients demonstrated significant agitation after receiving naloxone for opioid toxidrome, presumably because of the removal of the depressant effect of opioids, which unmasked the excitatory effects of the synthetic cannabinoids. Three patients required physostigmine along with the benzodiazepines for control of their agitation, urine retention and abnormal vitals, suggesting the possibility of an anticholinergic toxidrome to have developed in these patients.

Conclusion: Heroin contaminated with 5F-MDMB-PINACA exhibits variable severities of anticholinergic effects, some on presentation and others only after opiate antagonism.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220005/

'Orthopedic surgeons specialize in the treatment of conditions involving the musculoskeletal system. They are the third highest prescribers of opioids among physicians in the United States.

Investigators reported that that the "implementation of medical THC-grade cannabis laws and patient accessibility to in-state dispensaries are each associated with significantly reduced opioid prescribing by orthopedic surgeons."'
https://norml.org/news/2020/05/28/study-orthopedic-surgeons-issue-fewer-opioid-prescriptions-following-medical-cannabis-legalization

'As with past studies examining correlations between medical marijuana and opioid prescriptions, the Columbia analysis found a marked drop in prescriptions among states with medical cannabis laws (MCLs). “State MCLs were associated with a statistically significant reduction in aggregate opioid prescribing of 144,000 daily doses (19.7% reduction) annually,” the study, published this month in the Journal of the American Academy of Orthopaedic Surgeons, says.

Medical cannabis laws “were associated with a statistically significant reduction of 72,000 daily doses of hydrocodone annually.”'
https://www.marijuanamoment.net/states-with-medical-marijuana-laws-saw-20-drop-in-some-opioid-prescriptions/

'After his death, a notebook of poetry written by Morrison was recovered, titled Paris Journal; amongst other personal details, it contains the allegorical foretelling of a man who will be left grieving and having to abandon his belongings, due to a police investigation into a death connected to the Chinese opium trade. "Weeping, he left his pad on orders from police and furnishings hauled away, all records and mementos, and reporters calculating tears & curses for the press: 'I hope the Chinese junkies get you' and they will for the [opium] poppy rules the world".' - https://en.wikipedia.org/w/index.php?title=Jim_Morrison#Poetry_and_film

'An addict may be ten years off the junk, but he can get a new habit in less than a week; whereas someone who has never been addicted would have to take two shots per day for two months to get any habit at all. I took a shot daily for four months before I could notice withdrawal symptoms. You can list the symptoms of junk sickness, but the feel of it is like no other feeling and you can not put it into words. I did not experience this junk sick feeling until my second habit.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Results
Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period. Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months. Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment (P = 0.002). In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period.

Conclusions
Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.'
https://academic.oup.com/painmedicine/advance-article-abstract/doi/10.1093/pm/pnaa163/5859722

'Patients who were taking opioids prior to their enrollment in the study reduced their daily drug intake over the trial period – a finding that is consistent with those of other longitudinal studies, such as those here, here, and here. Investigators observed initial reductions in patients’ opioid consumption at three months. Patients further reduced their opioid intake at six months and again at twelve months.

Authors concluded, “Taken together, the results of this study add to the cumulative evidence in support of plant-based MC (medical cannabis) as a safe and effective treatment option and potential opioid substitute or augmentation therapy for the management of chronic pain symptomatology and quality of life.”'
https://norml.org/news/2020/06/25/study-cannabis-associated-with-reduced-opioid-use-prolonged-benefits-in-pain-patients

'Medicines for pain relief are unequally distributed across regions. More than 90 per cent of all pharmaceutical opioids available for medical consumption were in high-income countries in 2018. Some 50 per cent were in North America, 40 per cent in Europe, and a further 2 per cent in Oceania. Those countries are home to about 12 per cent of the global population. Low- and middleincome countries, which are home to 88 per cent of the global population, are estimated to consume less than 10 per cent of pharmaceutical opioids.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'At first we filled the scripts without too much trouble. But after a few weeks the scripts had piled up in the drugstores that would fill M[orphine] scripts and they began packing in. It looked like we would be back with Lupita. Once or twice we got short and had to score with Lupita. Using that good drugstore M had run up our habits, and so it took two of Lupita's fifteen-peso papers to fix us. Now, thirty pesos in one shot was a lot more than I could afford to pay. I had to quit, cut down to where I could make it on two of Lupita's papers per day, or find another source of supply.'

- Junky, William S Burroughs, 1977, originally published in 1953

'An estimated 192 million people used cannabis in 2018, making it the most used drug globally. In comparison, 58 million people used opioids in 2018. But that lower number of users belies the harm associated with opioids. This group of substances accounted for 66 per cent of the estimated 167,000 deaths related to drug use disorders in 2017 and 50 per cent of the 42 millions years (or 21 million years) lost due to disability or early death, attributed to drug use.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'In West, Central and North Africa, the opioid crisis is fuelled by tramadol; in North America, by fentanyls. Although those subregions have little in common in terms of economics, demographics or general patterns of drug use, both are struggling with an opioid crisis fuelled by substances that are easy to access and cheap to produce.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'Ease of manufacturing and low production costs helped to seed both crises, as did the context of an absence of international regulations on tramadol and many fentanyl analogues or their precursors. Both crises were inflamed by the availability of the substances on pharmaceutical and illicit markets – making it more difficult to detect and prevent their misuse.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'People with drug use disorders are particularly vulnerable to comorbidities that can lead to a poor outcome if they become infected with COVID-19. The same is true for anyone who uses drugs regularly. People who use opioids have a high risk of comorbidities such as chronic obstructive pulmonary disease, whereas stimulant users are particularly susceptible to inflammation of and damage to the lung tissue. Users of both drug types may already have a compromised immune system and an increased risk of cardiovascular diseases. These underlying conditions can put people who use drugs regularly at a high risk of complications and mortality if they become infected with COVID-19' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_1.pdf

'Opioids, which include opiates (heroin and opium) and pharmaceutical and other synthetic opioids, are a major concern in many countries because of the severe health consequences associated with their use. For example, in 2017, the use of opioids accounted for nearly 80 per cent of the 42 million years of “healthy” life lost as a result of disability and premature death (disability-adjusted life years, or DALYs) and 66 per cent of the estimated 167,000 deaths attributed to drug use disorders.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'One of the script-writing doctors suggested to Ike that he apply for a government permit. Ike explained to me that the Mexican government issued permits to hips allowing them a definite quantity of morphine per month at wholesale prices. The doctor would put in an application for Ike for one hundred pesos. I said, "Go ahead and apply." and gave him the money. I did not expect the deal to go through, but it did. Ten days later, he had a government permit to buy fifteen grams of morphine every month. The permits had to be signed by his doctor and the head doctor at the Board of Health. Then he could take it to a drugstore and have it filled.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Although global estimates are not available, the nonmedical use of pharmaceutical opioids is reported in many countries, in particular in countries in West and North Africa and the Near and Middle East (tramadol), and in North America (hydrocodone, oxycodone, codeine, tramadol and fentanyl).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'With the exception of Nigeria, where 4.6 million people were estimated to have used opioids – mainly tramadol – in 2017, population-level prevalence estimates of the use of opioids are not available for countries in West, Central and North Africa. However, many countries in those subregions report high levels of non-medical use of tramadol. For example, in Egypt, 2.5 per cent of male and 1.4 per cent of female students aged 15–17 had misused tramadol in the past year. Students in that country also reported the use, to a lesser degree, of heroin or opium/morphine in 2016. Furthermore, data on the provision of treatment suggest that the prevalence of the non-medical use of opioids is quite high in Egypt. Tramadol tablets available in some parts of Africa are reportedly intended for the illicit market and may be of a dosage higher than usually prescribed for medical purposes.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The opioid crisis continues in North America, with a new record level in the number of opioid overdose deaths attributed to the use of fentanyl and its analogues. These substances are added to heroin and other drugs as adulterants and are also sold as counterfeit prescription opioids, such as oxycodone or hydrocodone, and even as counterfeit benzodiazepines, to a large unsuspecting population of users of opioids and other drugs. In 2018, in the United States, 10.3 million people or 3.7 per cent of the population aged 12 and older had misused opioids in the past year. Of those people, 9.9 million (3.6 per cent of the population) reported the non-medical use of prescription opioids while nearly 800,000 reported past-year use of heroin.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The number of overdose deaths in the United States reached its peak in 2017 at 70,237 deaths (21.7 deaths per 100,000 population), of which 47,600 (68 per cent: 14.9 deaths per 100,000 population) were attributed to opioids. In 2018, for the first time since 1999, the number of overdose deaths declined over the previous year by 4 per cent to 67,367 deaths (20.7 deaths per 100,000 population). Opioids were responsible for most of those deaths, accounting for 46,802 in total in 2018 (14.6 deaths per 100,000 population), of which 67 per cent were attributed to fentanyls.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'There are also signs of increasing non-medical use of pharmaceutical opioids in Western and Central Europe, as reflected in the increasing proportion of treatment admissions for the use of those substances in recent years. In 2017, users of pharmaceutical opioids, including misused methadone, buprenorphine, fentanyl, codeine, morphine, tramadol and oxycodone, accounted for 22 per cent of all clients entering drug treatment in the subregion for opioid use disorders (as their primary drug).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'A major drug use survey carried out recently in India found that in 2018, 2.1 per cent of the population aged 10–75, a total of 23 million people, had used opioids in the past year. Among opioids, heroin is the most prevalent substance, with a past-year prevalence of 1.1 per cent among the population aged 10–75; this is followed by the non-medical use of pharmaceutical opioids, with a past-year prevalence of almost 1 per cent, and by opium at almost 0.5 per cent. In general, the past-year use of opioids is much higher among men (4 per cent of the male population) than women (0.2 per cent of the female population). Moreover, 1.8 per cent of adolescents aged 10–17 are estimated to be past-year opioid users. Of the 23 million past-year opioid users, roughly one third, or 7.7 million people, suffer from opioid use disorders. Compared with earlier estimates from a survey carried out in 2004, overall opioid use in India is estimated to have increased fivefold.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Aside from junk itself, what you experience during a habit is flat, almost two-dimensional. You can remember what happened if you take the trouble, but no memories come back spontaneously from a habit period - except for the intervals of sickness.'

- Junky, William S Burroughs, 1977, originally published in 1953

'In Africa, the increasing proportion of people treated for opioid use disorders likely reflects the increasing use of opioids, especially tramadol, in West and Central Africa. In that subregion, opioids (heroin and tramadol) were, after cannabis, the second most common drug type for which people accessed drug treatment services over the period 2014–2017.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The increase in treatment demand related to cannabis use disorders in some regions warrants special attention. There is great variability in the definition and practice of what constitutes treatment of cannabis use disorders. Treatment at present consists of behavioural or psychosocial interventions, such as cognitive behavioural therapy (in which irrational, negative thinking styles are challenged and the development of alternative coping skills is promoted) and motivational interviewing (in which a user’s personal motivation to change their own behaviour is facilitated and engaged). These interventions may vary from one-time online contact or screening and brief intervention in an outpatient setting, to a more comprehensive treatment plan including treatment of other comorbidities in an outpatient or inpatient setting. Some of the factors that may influence the number of people in treatment for cannabis use disorders include changes in the number of people who actually need treatment; changes in the treatment referral system; changes in awareness of potential problems associated with cannabis use disorders; and changes in the availability of and access to treatment for cannabis use disorders.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Opioids (predominantly heroin) remain the main drug for which people undergo drug treatment in Europe (in particular Eastern and South-Eastern Europe) and Asia, accounting for nearly 50 per cent of all treatment admissions in 2018. Compared with users of other drugs, those with opioid use disorders entering treatment tend to be older, in their midthirties, and between one quarter and one third of them are first-time entrants. This corresponds to findings published in scientific literature, for instance studies from Europe, which suggest that there is an ageing cohort of opioid users in Europe.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The health consequences of drug use can include a range of negative outcomes such as drug use disorders, mental health disorders, HIV infection, hepatitis-related liver cancer and cirrhosis, overdose and premature death. The greatest harms to health are those associated with the use of opioids and with injecting drug use, owing to the risk of acquiring HIV or hepatitis C through unsafe injecting practices.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'C[ocaine] is hard to find in Mexico. I had never used any good coke before. Coke is pure kick. It lifts you straight up, a mechanical lift that starts leaving you as soon as you feel it. I don't know anything like C for a lift, but the lift lasts only ten minutes or so. Then you want another shot. You can't stop shooting C - as long as it is there you shoot it. When you are shooting C, you shoot more M[orphine] to level the C kick and smooth out the rough edges. Without M, C makes you too nervous, and M is an antidote for an overdose. There is no tolerance with C, and not much margin between a regular and a toxic dose. Several times I got too much and everything went black and my heart began turning over. Luckily I always had plenty of M on hand, and a shot of M fixed me right up.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Injecting drug use is a significant public health concern and causes morbidity and mortality owing to the risk of overdose and blood-borne infections (mainly HIV and hepatitis B and C), transmitted through the sharing of contaminated needles and syringes and other drug paraphernalia or risky sexual behaviour in some groups and subsequent severe immunosuppression, cirrhosis, neoplastic disease and inflammation sequelae. Social and physical effects can further aggravate potential underlying mental health conditions.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Owing to the criminalization of drug use, punitive laws, stigma and discrimination against people who use or inject drugs in many parts of the world, conventional survey methods have been found to underestimate the actual population size because of the hidden nature of PWID [persons who inject drugs]; therefore, only indirect methods have been shown to reflect the situation of PWID with greater accuracy. Overall, new or updated estimates of PWID were available for 40 countries in 2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'The prevalence of PWID [persons who inject drugs] aged 15–64 in 2018 continues to be the highest in Eastern Europe (1.26 per cent) and Central Asia and Transcaucasia (0.63 per cent). Those percentages are, respectively, 5.5 and 2.8 times higher than the global average. More than a quarter of all PWID reside in East and South-East Asia, although the prevalence itself is relatively low (0.19 per cent). The three subregions with the largest numbers of PWID (East and South-East Asia, North America and Eastern Europe) together account for over half (58 per cent) of the global number of PWID. It is noteworthy that, as in previous years, while three countries – China, the Russian Federation and the United States – account for just 27 per cent of the global population aged 15–64, they are home to almost half (43 per cent) of all PWID.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Injecting drug use is estimated to account for approximately 10 per cent of HIV infections worldwide and 30 per cent of all HIV cases outside Africa, while in the eastern countries of the WHO European Region more than 80 per cent of all HIV infections occur among PWID [persons who inject drugs]. PWID are estimated to be 22 times more likely than people in the general population to be living with HIV.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Junk is a biological necessity when you have a habit, an invisible mouth. When you take a shot of junk you are satisfied, just like you ate a big meal. You don't want another shot right away.'

- Junky, William S Burroughs, 1977, originally published in 1953

'The largest number of PWID [persons who inject drugs] living with HIV reside in Eastern Europe, East and South-East Asia and South-West Asia, which together account for 67 per cent of the global total. Although the prevalence of HIV among PWID (9.3 per cent) is below the global average, a fifth of the global number of PWID living with HIV reside in East and South-East Asia. A small number of countries continue to account for a large proportion of the total global number of PWID living with HIV. In 2018, for example, PWID living with HIV in China, Pakistan and the Russian Federation accounted for almost half of the global total (49 per cent), while PWID in those three countries comprise only a third of all PWID worldwide.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'PWID [persons who inject drugs] are a key population affected by hepatitis C. Global estimates suggest that 71 million people worldwide were chronically infected with hepatitis C in 2017 and that 23 per cent of new hepatitis C infections and one in three hepatitis C-related deaths are attributable to injecting drug use. Hepatitis C-related morbidity and mortality continue to rise, mainly as a result of cirrhosis, hepatocellular carcinoma and death in cases of untreated hepatitis C' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'UNODC, WHO, UNAIDS and the World Bank jointly estimated the prevalence of hepatitis C among PWID [persons who inject drugs] worldwide in 2018 to be 48.5 per cent, or 5.5 million (range: 4 million to 7.8 million) people aged 15–64. This estimate is based on estimates in 108 countries, covering 94 per cent of the estimated global number of PWID.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Although data coverage was low in the Caribbean, the highest prevalence of hepatitis C among PWID [persons who inject drugs] was found in that subregion, at 76 per cent, followed by East and South-East Asia, Western and Central Europe, North America, and Central Asia and Transcaucasia, where it ranged between 61 and 54 per cent. In North Africa, a hepatitis C prevalence of 25 per cent was found among PWID, compared with a combined prevalence in the general population (>15 years) in North Africa and the Middle East estimated at 3.1 per cent. In Central Asia, a hepatitis C prevalence of 54 per cent was found among PWID, compared with a range of 0.5 to 13.1 per cent among the general population' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf

'Junk takes everything and gives nothing but insurance against junk sickness. Every now and then I took a good look at the deal I was giving myself and decided to take the cure. When you are getting plenty of junk, kicking looks easy. You say, "I'm not getting any kick from the shots any more. I might as well quit." But when you cut down into junk sickness, the picture looks different.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Opium is illicitly produced in some 50 countries worldwide, although the three countries where most opium is produced have accounted for about 97 per cent of global opium production over the past five years. Afghanistan, the country where most opium is produced, which has accounted for approximately 84 per cent of global opium production over the past five years, supplies markets in neighbouring countries, Europe, the Near and Middle East, South Asia and Africa and to a small degree North America (notably Canada) and Oceania. Countries in SouthEast Asia – mostly Myanmar (some 7 per cent of global opium production) and, to a lesser extent, the Lao People’s Democratic Republic (about 1 per cent of global opium production) – supply markets in East and South-East Asia and Oceania. Countries in Latin America – mostly Mexico (6 per cent of global opium production) and, to a far lesser extent, Colombia and Guatemala (less than 1 per cent of the global total) – account for most of the heroin supply to the United States and supply the comparatively small heroin markets of South America.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Despite a long-term upward trend, the global area under opium poppy cultivation declined by 17 per cent in 2018 and then by 30 per cent in 2019, falling to an estimated 240,800 ha. Declines in the area under cultivation were reported in both Afghanistan and Myanmar in 2018 and 2019. Despite the recent declines, the global area under opium poppy cultivation is nevertheless still substantially larger than a decade ago and at similar level of the global area under coca cultivation' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Despite global opium production in 2018 being less than in 2017, there have been no indications to date of a shortage in the supply of heroin to the respective consumer markets. In 2018 and 2019, both opium and heroin prices declined in the main opium production areas in Afghanistan, with opium farmgate prices falling by an average of 37 per cent (on a year earlier) in 2018 and by 24 per cent in 2019, while high-quality heroin prices fell by an average of 11 per cent in 2018 and by 27 per cent in 2019 in Afghanistan. Due to the bumper opium harvest of 2017, opium prices showed significant declines at an earlier stage (starting in 2017) than did heroin prices (basically starting in 2018), suggesting that it may have taken some time for clandestine heroin manufacture to adjust to the overall greater availability of opium before expanding, as later reflected in lower heroin prices. At the same time, data also show that, following two years of decreased opium production as compared with 2017, the downward trend in drug prices came to a halt, in the case of opium, in June 2019, and a few months later, in August 2019, in the case of heroin as well.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The opiate seized in the largest quantity in 2018 continued to be opium (704 tons), followed by heroin (97 tons) and morphine (43 tons). Expressed in heroin equivalents, however, heroin continued to be seized in larger quantities than opium or morphine. Globally, 47 countries reported opium seizures, 30 countries reported morphine seizures and 103 countries reported heroin seizures in 2018, suggesting that trafficking in heroin continues to be more widespread in geographical terms than trafficking in opium or morphine.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'During the year or so I was on junk in Mexico, I started the cure five times. I tried reducing the shots, I tried the Chinese cure with a solution of hop and Wampole's medicine. Every time you take some of the hop solution you add an equal amount of Wampole's medicine. In ten days or so you are drinking plain Wampole's Tonic, and the reduction was so slow you never noticed.
That is the theory of the Chinese cure. What generally happens is this: You start taking a little more hop solution than your schedule allows and that means you put in more Wampole's and dilute the hop that much quicker. After a few days you don't know how much there is in there and you take it all to be sure. So you wind up with a worse habit than you had before the Chinese cure.'

- Junky, William S Burroughs, 1977, originally published in 1953

'The quantities of opium and morphine seized continued to be concentrated in just a few countries in 2018, with three countries accounting for 98 per cent of the global quantity of opium seized and 97 per cent of the global quantity of morphine seized. By contrast, seizures of heroin continue to be more widespread, with 54 per cent of the global quantity of heroin seized in 2018 accounted for by the three countries with greatest seizures.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Most opiates seized are reported in or close to the main opium production areas. Thus Asia, host to more than 90 per cent of global illicit opium production and the world’s largest consumption market for opiates, accounted for almost 80 per cent of all opiates seized worldwide, as expressed in heroin equivalents, in 2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The largest quantities of opiates continued to be seized in South-West Asia in 2018, accounting for 98 per cent of the global quantity of opium seized, 97 per cent of the global quantity of morphine seized and 38 per cent of the global quantity of heroin seized that year (i.e., equivalent to 70 per cent of all opiates seized globally as expressed in heroin equivalents). Overall, 690 tons of opium, 42 tons of morphine and 37 tons of heroin were seized in South-West Asia in 2018' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The largest quantities of both opium and morphine seized were reported by the Islamic Republic of Iran, followed by Afghanistan and Pakistan, while seizures reported by other countries remained comparatively modest. The largest total quantity of heroin seized by a country in 2018 was that seized by the Islamic Republic of Iran (for the first time since 2014), followed by Turkey, the United States, China, Pakistan, Afghanistan and Belgium.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'An eating habit is the worst habit you can contract. It takes longer to break than a needle habit, and the withdrawal symptoms are considerably more severe. In fact, it is not uncommon for a junkie with an eating habit to die if he is cut off cold turkey in jail. A junkie with an eating habit suffers from excruciating stomach cramps when he is cut off. And the symptoms last up to three weeks as compared to eight days on a needle habit.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Almost 70 per cent of the global quantities of heroin and morphine (the two main internationally trafficked opiates) seized in 2018 were intercepted in Asia, mostly in South-West Asia. The two subregions surrounding Afghanistan, South-West Asia and Central Asia, together accounted for more than 56 per cent of the global quantity of heroin and morphine seized

Despite the decline in 2018, the overall trend in seizures of heroin and morphine in that subregion continued to be an upward one over the period 2008–2018. South-West Asia continued to account for the majority of the global quantities of heroin and morphine seized globally in 2018 (close to 56 per cent), with the largest quantities seized being reported by the Islamic Republic of Iran, followed by Afghanistan and Pakistan.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The largest total quantity of heroin and morphine seized in a region outside Asia is that reported for Europe (22 per cent of the global total in 2018), which is an important market for the consumption of heroin. Heroin and morphine seized in Eastern and South-Eastern Europe continued to account for the bulk (66 per cent) of all such quantities seized in Europe in 2018, with most of the heroin and morphine seized in the region continuing to be reported by Turkey (62 per cent), followed by Western and Central Europe (31 per cent) and Eastern Europe (3 per cent) in 2018' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'While the strongest increase in the quantities of heroin and morphine seized in 2017 was reported in Eastern and South-Eastern Europe (the same year as the bumper opium harvest reported in Afghanistan), the strongest increase in 2018 was reported in Western and Central Europe (89 per cent). This suggests that it may take a year from when opium is harvested in Afghanistan until it is manufactured into the heroin that ends up on the streets of Western and Central Europe. There were increases in heroin and morphine seizures in Europe in the countries along the Balkan route in 2018, although most of the increase was due to an increase in the quantities of heroin and morphine seized in Belgium and, to a lesser extent, in France and Italy.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'In contrast to Western and Central Europe as a whole, which continues to be supplied mainly by heroin trafficked along the Balkan route by land, trafficking to Belgium in 2018 to a large extent (98 per cent) took the form of maritime shipments departing from the Islamic Republic of Iran or Turkey. Similarly, trafficking to Italy was characterized by maritime shipments in 2018 (61 per cent of the total quantity seized by customs authorities), with the bulk of seizures in 2018 having departed from the Islamic Republic of Iran in containers, followed by shipments by air (37 per cent), often departing from the Middle East (Qatar) or Africa (South Africa), while heroin shipments destined for France typically transited the Netherlands and Belgium in 2018' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'When you kick the spike you get worse until you hit the third day and you think, this is it: You couldn't feel worse. But the fourth day is worse. After the fourth day relief is dramatic. And on the sixth day there is only a pale shadow of junk sickness.
But with an eating habit you can look forward to at least ten days of horrible suffering. So when you are taking a cure with hop you have to be careful not to get an eating habit. If you can't make it on schedule, best go back to the needle.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Heroin trafficking in the Americas remains concentrated in North America. The subregion accounted for 94 per cent of all quantities of heroin and morphine seized in the Americas in 2018, when seizures reported in North America were almost four times as high as a decade earlier. Seizures made in the United States accounted for 87 per cent of all heroin and morphine seized in the Americas in 2018, followed by Mexico (the country where most opium is produced in the region), Colombia, Ecuador, Brazil, Canada and Guatemala.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The world’s single largest heroin trafficking route continues to be the so-called “Balkan route”, along which opiates from Afghanistan are shipped to Iran (Islamic Republic of), Turkey, the Balkan countries and to various destinations in Western and Central Europe. Not counting seizures made in Afghanistan itself, countries along the Balkan route accounted for 58 per cent of the global quantities of heroin and morphine seized in 2018. A further 8 per cent of those global seizures were reported by countries in Western and Central Europe, whose markets are supplied to a great degree by heroin and morphine that is trafficked along the Balkan route' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'In line with the dominance of the opium production in Afghanistan, quantities of heroin and morphine seized related to Afghan opiate production accounted for some 84 per cent of the global total in 2018, a slight decrease from 88 per cent in 2017, the year of the bumper harvest in the country. Most of the heroin found in Europe, Central Asia/ Transcaucasia and Africa is derived from opium of Afghan origin, accounting for 100 per cent of all mentions in the responses to the annual report questionnaire by countries in Central Asia/Transcaucasia, 96 per cent in Europe and 87 per cent in Africa over the period 2014–2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The Islamic Republic of Iran reported that 75 per cent of the morphine and 75 per cent of the heroin seized on its territory in 2018 had been trafficked via Pakistan, while the remainder had been smuggled directly into the country from Afghanistan. Typically, heroin is then smuggled to Turkey (70 per cent of all the heroin seized in the Islamic Republic of Iran in both 2016 and 2017) and from there along the Balkan route to Western and Central Europe, either via the western branch of the route via Bulgaria to various western Balkan countries or, to a lesser extent, via the eastern branch of the route via Bulgaria and then to Romania and Hungary, before reaching the main consumer markets in Western and Central Europe' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'The main countries identified in which heroin was trafficked along the southern route to Western and Central Europe over the period 2014– 2018 included India, the Gulf countries (notably Qatar and United Arab Emirates) and a number of Southern and East African countries (notably South Africa, Kenya, Ethiopia, Mozambique, the United Republic of Tanzania, Rwanda, Burundi, Uganda and Madagascar). The European countries reporting most trafficking along the southern route over the period 2014–2018 were Belgium (mostly via Kenya, Burundi, Rwanda, Uganda, South Africa, Ethiopia and the United Republic of Tanzania) and Italy (mostly via Qatar, the United Arab Emirates, South Africa, Ethiopia, Madagascar and Oman).' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'I knew that I did not want to go on taking junk. If I could have made a single decision, I would have decided no more junk ever. But when it came to the process of quitting, I did not have the drive. It gave me a terrible feeling of helplessness to watch myself break every schedule I set up as though I did not have control over my actions.'

- Junky, William S Burroughs, 1977, originally published in 1953

'The most significant trafficking activities worldwide of opiates not of Afghan origin concern opiates produced in South-East Asia (mostly Myanmar), which are trafficked to other markets in East and SouthEast Asia (mostly China and Thailand) and to Oceania (mostly Australia). Seizures made in those countries accounted for 11 per cent of the global quantities of heroin and morphine seized (excluding seizures made by Afghanistan) in 2018, down from 15 per cent in 2015. This went in parallel with reported reductions in opium production in Myanmar of 20 per cent over the period 2005–2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Most heroin (and morphine) trafficking in the Americas continues to take place within North America, i.e., from Mexico to the United States and, to a far lesser extent, from Colombia and from Guatemala (typically via Mexico) to the United States. Based on forensic profiling, United States authorities estimated in 2017 that over 90 per cent of the heroin samples analysed originated in Mexico and 4 per cent in South America, while around 1 per cent originated in South-West Asia. This stands in stark contrast to a decade earlier (2007), when only 25 per cent was sourced from Mexico and 70 per cent was imported from South America.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'While the annual prevalence of methamphetamine use more than doubled from 0.3 to 0.7 per cent of the population aged 12 and older in the United States over the period 2008–2018, the number of psychostimulants involved in drug poisoning deaths in the United States rose from 1,302 to 12,676 deaths over the same period, equivalent to an almost 10-fold increase. This increase may have been inflated by an increasing number of contaminations of psychostimulants with opioids (such as fentanyl and its analogues); however, psychostimulant-related deaths excluding any involvement of opioids still showed an eightfold increase, from 807 deaths in 2008 to 6,271 deaths in 2018.' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_3.pdf

'Ninety percent of those currently using cannabis for pain management said that it provided either moderate or significant relief and 40 percent of subjects reported having decreased their consumption of other analgesic medications following their initiation of cannabis therapy. Pain patients most frequently reported consuming products high in CBD rather than THC.'
https://norml.org/news/2020/07/09/survey-one-in-five-patients-report-using-cannabis-products-for-musculoskeletal-pain

'I had never been able to drink before when I was on the junk, or junk sick. But eating hop is different from shooting the white stuff. You can mix hop and lush.
At first I started drinking at five in the afternoon. After a week, I started drinking at eight in the morning, stayed drunk all day and all night, and woke up drunk the next morning.
Every morning when I woke up, I washed down benzedrine, sanicin, and a piece of hop with black coffee and a shot of tequila. Then I lay back and closed my eyes to piece together the night before and yesterday. Often, I drew a blank from noon on. You sometimes wake up from a dream and think, "Thank God, I didn't really do that!" Reconstructing a period of blackout you think, "My God, did I really do it?" The line between saying and thinking is blurred. Did you say it or just think it?'

- Junky, William S Burroughs, 1977, originally published in 1953

'The situation is particularly complex for the opioids group, as both legally and illegally produced substances satisfy the non-medical demand for opioids. While illegally produced opiates, such as heroin, used to dominate the non-medical demand for opioids, the illicit opioid markets in many countries have become far more diversified over the past two decades, with a number of pharmaceutical opioids that have started to cover a substantial part of the market for opioids for non-medical purposes.

This is creating an additional challenge for drug use prevention because, unlike the traditional hard drugs such as heroin, pharmaceuticals are often not perceived as harmful. In terms of drug control, this requires a careful equilibrium between maximizing accessibility for medical use while minimizing availability for non-medical use. It should be noted that the use of pharmaceuticals for non-medical purposes is not limited to opioids. There is also a substantial market for stimulant pharmaceuticals for non-medical use, particularly in Latin America and the Caribbean' - United Nations Office on Drugs and Crime, World Drug Report 2020, https://wdr.unodc.org/wdr2020/field/WDR20_BOOKLET_4.pdf

'In 2018, India was the main producer of raw opium (in addition to being the only country legally exporting raw opium), producing 225.4 tons (24.8 tons in morphine equivalent) and accounting for 97.1 per cent of global production. It was followed by China, which produced 6.6 tons (0.7 ton in morphine equivalent). In China, opium had been the main raw material used in the manufacture of alkaloids until 2000; after that, it was replaced by poppy straw. Japan also produced smaller amounts of opium in 2018, to be used exclusively for scientific purposes. India accounted for 96 per cent of opium exports in 2018. The remaining 4 per cent was accounted for by re-exports of opium by countries that had initially imported the opium from India'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'The main countries importing opium in 2018 were Japan (36 tons, or 67.3 per cent) followed by France (11.1 tons, or 20.7 per cent) and the Islamic Republic of Iran (5 tons, or 9.3 per cent). The United States, which had been the main importer of opium, reported the import of only a negligible amount of opium from India in 2018.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'Ike took a very severe view of my drinking. "You're drinking, Bill. You're drinking and getting crazy. You look terrible. You look terrible in your face. Better you should go back to stuff than drink like this."

- Junky, William S Burroughs, 1977, originally published in 1953

'In 2018, the main countries reporting utilization of opium for the extraction of alkaloids were the Islamic Republic of Iran (511.8 tons, or 56.3 tons of morphine equivalent), India (138.5 tons, or 15.2 tons in morphine equivalent) and Japan (41.6 tons, or 4.6 tons in morphine equivalent). The opium reported as utilized by the Islamic Republic of Iran originated from seized material.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, the main countries utilizing poppy straw (Morphine) were Turkey (17,253.0 tons in gross weight), Spain (7,384.5 tons), France (5,710.1 tons), Australia (3,452.3 tons), Slovakia (1,644.4 tons) and China (1,361.7 tons). Belgium and North Macedonia each utilized less than 1,000 tons of poppy straw (M) in 2018.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2013, the leading morphine manufacturing country was France (93.5 tons, or 17.9 per cent of global manufacture), followed by the United Kingdom (88.5 tons—a decrease from 110 tons in 2012—or 17 per cent), the United States (88.2 tons, or 16.9 per cent), Spain (76 tons, or 14.6 per cent), Australia (54.6 tons, or 10.4 per cent), Norway (20.8 tons, or 4 per cent), China (18.8 tons, or 3.6 per cent) and Japan (15.1 tons, or 2.9 per cent). Together, these eight countries accounted for 87.3 per cent of global manufacture. Four other countries reported the manufacture of morphine in 2013 in quantities of more than 10 tons: Iran (Islamic Republic of) (13.7 tons), India (11 tons), Hungary (10.6 tons) and South Africa (10.4 tons).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2014/ND_TR_2014_2_Comments_EN.pdf

'Australia accounted for 54.1 per cent of global production of poppy straw (Codeine), while Spain accounted for the remaining 45.9 per cent. Australia also accounted for most of its utilization (87.2 per cent); it was followed by Spain (12.8 per cent). Stocks of poppy straw (C) were held only by Spain (55.1 tons), France (35.3 tons) and Australia (9.6 tons)'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2014/ND_TR_2014_2_Comments_EN.pdf

'In 2018, the leading morphine manufacturing country was France (86.4 tons, or 22.3 per cent of global manufacture), followed by the United Kingdom (83.7 tons, or 21.6 per cent), Australia (50.5 tons, or 13 per cent), the Islamic Republic of Iran (38.5 tons, or 9.9 per cent), Norway (21.1 tons, or 5.4 per cent), China (18.2 tons, or 4.7 per cent), the United States (17.7 tons, or 4.6 per cent), Japan (16.4 tons, or 4.2 per cent), Spain (13.1 tons, or 3.4 per cent) and India (12.0 tons, or 3.1 per cent). Together, those 10 countries accounted for 92.2 per cent of global manufacture of morphine.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2014/ND_TR_2014_2_Comments_EN.pdf

'Morphine exports decreased to 23.4 tons in 2016, before increasing again, to 28.1 tons, in 2017 and then decreasing again, to 24.7 tons, in 2018. The main exporting countries in 2018 were the United Kingdom (31.6 per cent), France (15.4 per cent), Switzerland (9.8 per cent), Germany (9.4 per cent), Australia (7.9 per cent), Italy (6.9 per cent) and the United States (6.6 per cent). Other countries accounted for less than 2 per cent of total exports of morphine.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2014/ND_TR_2014_2_Comments_EN.pdf

'I finally slept a little and woke up next morning with a terrific alcohol depression. Junk sickness, suspended by codeine and hop, numbed by weeks of constant drinking, came back on me full force. "I have to have some codeine," I thought.'

- Junky, William S Burroughs, 1977, originally published in 1953

'The main importing countries [of morphine] in 2018 were the United Kingdom (5.0 tons, or 19.6 per cent), Germany (4.5 tons, or 17.6 per cent), Austria (2.5 tons, or 9.9 per cent), Hungary (2.1 tons, or 8.3 per cent), Canada (1.7 tons, or 6.8 per cent), Australia (1.6 tons, or 6.1 per cent) and Switzerland (1.3 tons, or 5.2 per cent). Other countries imported less than 1 ton of morphine.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, 79 per cent of the world population, mainly persons in low- and middle-income countries, consumed only 13 per cent of the total amount of morphine used for the management of pain and suffering. Although the situation improved in the previous 20 years, the disparity in consumption of narcotic drugs for palliative care continues to be a matter of concern, particularly in relation to access and availability of affordable opioid analgesics such as morphine. The remaining 87 per cent of the total consumption of morphine, excluding preparations in Schedule III of the 1961 Convention, continued to be concentrated in a small number of countries, mainly in Europe and North America. In 2018, European countries as a whole and the United States accounted for the highest share of global morphine consumption (39.5 per cent and 39.3 per cent respectively); they were followed by Canada (5.1 per cent), Australia and New Zealand (2.5 per cent) and Japan (0.6 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'The main countries manufacturing codeine were the United Kingdom (accounting for 68.3 tons, or 22.2 per cent of global manufacture), France (60.0 tons, or 19.5 per cent), Australia (40.7 tons, or 13.2 per cent), the Islamic Republic of Iran (22.2 tons, or 7.2 per cent) and the United States (21.9 tons, or 7.1 per cent)'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, world exports of codeine increased to 158.8 tons, compared with 139.2 tons in 2017, almost reaching the peak of 176.5 tons recorded in 2012 (see figure 16), and the United Kingdom became, for the first time, the main country exporting codeine (accounting for 35.2 tons, or 22.2 per cent of the global exports). It was followed by France (30.5 tons, or 19.2 per cent), Australia (29.5 tons, or 18.6 per cent), Norway (15.8 tons, or 9.9 per cent), the Islamic Republic of Iran (10.4 tons, or 6.6 per cent), Spain (6.6 tons, or 4.2 per cent), Italy (6.6 tons, or 4.1 per cent), Switzerland (5.9 tons, or 3.7 per cent), Slovakia (4.4 tons, or 2.8 per cent) and Hungary (3.9 tons, or 2.5 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'The 10 main countries importing codeine in 2018 were India (35.9 tons), Germany (19.1 tons), Canada (11.7 tons), the United Kingdom (9.5 tons), Brazil (9.2 tons), Italy (8.8 tons), Hungary (7.0 tons), Viet Nam (6.7 tons), Switzerland (4.9 tons) and Oman (4.4 tons).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'Ike came back from the bathroom with the works and began cooking up a shot. He kept talking. "You're drinking and you're getting crazy. I hate to see you get off this stuff and on something worse. I know so many that quit the junk. A lot of them can't make it with Lupita. Fifteen pesos for a paper and it takes three to fix you. Right away they start in drinking and they don't last more than two or three years."

- Junky, William S Burroughs, 1977, originally published in 1953

'According to the data reported for 2018, codeine was consumed mainly in India (46.1 tons, or 20.2 per cent of global consumption), the Islamic Republic of Iran (22.2 tons, or 9.8 per cent), France (20.6 tons, or 9.1 per cent), the United States (20.1 tons, or 8.8 per cent), Germany (15 tons, or 6.6 per cent), the United Kingdom (12.4 tons, or 5.5 per cent) and Canada (11.1 tons, or 4.9 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, a total of 1,342.3 kg of [licit] heroin was manufactured, mostly by the United Kingdom (924.8 kg, or 68.9 per cent of global manufacture), Switzerland (374.9 kg, or 27.9 per cent) and Spain (42.6 kg, or 3.2 per cent). The two main countries exporting heroin were the United Kingdom (313.0 kg, or 71.3 per cent of global exports) and Switzerland (118.3 kg, or 26.9 per cent). In 2018, the main importing country was the Netherlands (167 kg, or 38.4 per cent of global imports), followed by Switzerland (121.8 kg, or 28.0 per cent), Germany (54.4 kg, or 12.5 per cent), Denmark (39.3 kg, or 9.1 per cent), the United Kingdom (28.3 kg, or 6.5 per cent), Canada (16.5 kg, or 3.8 per cent) and Luxembourg (7.3 kg, or 1.7 per cent)'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'The principal exporting countries [of fentanyl] were Germany (417.1 kg, or 44.6 per cent of global exports), Belgium (241.7 kg, or 25.9 per cent), the United States (90.7 kg, or 9.7 per cent) and the United Kingdom (64.3 kg, or 6.9 per cent).
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'Germany was also the principal importing country for fentanyl in 2018 (434.7 kg, or 35.5 per cent of global imports); it was followed by Spain (125.1 kg, or 10.2 per cent), the United Kingdom (111.2 kg, or 9.1 per cent), France (73.9 kg, or 6.0 per cent), Italy (54.6 kg, or 4.5 per cent) and the Netherlands (53.2 kg, or 4.3 per cent).'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, fentanyl was mainly manufactured by the United States (740.7 kg, or 39.1 per cent of global manufacture), followed by Germany (548.3 kg, or 28.9 per cent), South Africa (238.4 kg, or 12.6 per cent), Belgium (229.8 kg, or 12.1 per cent) and the United Kingdom (94.7 kg, or 5.0 per cent). '
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'In 2018, most of the consumption of fentanyl (81.7 per cent) was concentrated in 10 countries, all of which were high-income countries. The three largest consumers of fentanyl were the United States (accounting for 20.8 per cent of global consumption, or 307.9 kg), Germany (17.6 per cent, or 259.4 kg) and the United Kingdom (15.6 per cent, or 230.6 kg). Other major consumers of fentanyl were, in descending order of the amounts consumed, Spain, Italy, France, the Netherlands, Canada, Australia and Belgium.'
https://www.incb.org/documents/Narcotic-Drugs/Technical-Publications/2019/Narcotic_Drugs_Technical_Publication_2019_web.pdf

'When I jumped bail and left the States, the heat on junk already looked like something new and special. Initial symptoms of nationwide hysteria were clear. Louisiana passed a law making it a crime to be a drug addict. Since no place or time is specified and the term "addict" is not clearly defined, no proof is necessary or even relevant under a law so formulated. No proof, and consequently, no trial. This is police-state legislation penalizing a state of being. Other states were emulating Louisiana. I saw my chance of escaping conviction dwindle daily as the anti-junk feeling mounted to a paranoid obsession, like anti-Semitism under the Nazis. So I decided to jump bail and live permanently outside the United States.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Not long ago, Stanford psychiatrist Anna Lembke would refuse to treat anyone who used opioids, believing that there wasn’t much she could do until they stopped abusing the addictive painkiller. Since researching and writing her new book, “Drug Dealer, M.D.,” she has come to a very different way of thinking and understanding of how doctors themselves have been acting as drug dealers.'

https://www.youtube.com/watch?v=AsbJGfK0evk

'Highlights - delta9-tetrahydrocannabinol (THC) enhances the antinociceptive effects of oxycodone; Vaporized and injected THC reduces oxycodone self-administration; Cannabinoids may reduce opioid use for analgesia; Cannabinoids may reduce nonmedical opioid use.'

https://www.sciencedirect.com/science/article/pii/S0028390819301212

Cannabis and opium don't get along?

'The multi-systemic effects of cannabinoids and their pharmacological interactions with anesthetic agents may lead to serious consequences. Low doses of cannabinoids have been associated with increased sympathetic response (tachycardia, hypertension and increased contractility) with high levels of norepinephrine detected 30?min after use. High doses enhance parasympathetic tone leading to dose-dependent bradycardia and hypotension. Severe vascular complications associated with cannabis exposure may include malignant arrhythmias, coronary spasm, sudden death, cerebral hypoperfusion and stroke. Bronchial hyperreactivity and upper airway obstruction are commonly reported in cannabis users. Postoperative hypothermia, shivering and increased platelet aggregation have been also documented.'

https://europepmc.org/abstract/MED/30852326

'When you give up junk, you give up a way of life. I have seen junkies kick and hit the lush and wind up dead in a few years. Suicide is frequent among ex-junkies. Why does a junkie quit junk of his own will? You never know the answer to that question. No conscious tabulation of the disadvantages and horrors of junk gives you the emotional drive to kick. The decision to quit junk is a cellular decision, and once you have decided to quit you cannot go back to junk permanently any more than you could stay away from it before. Like a man who has been away a long time, you see things different when you return from junk.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Current and former athletes self-medicating with opioids and other prescription drugs has become a hot-button issue in recent years.

Several studies have shown pro football players have misused additive pain killers, anti-inflammatories and antidepressants.

A study published in the Clinical Journal of Sport Medicine last year reported 26.2 per cent of retired National Football League players said they had used prescription opioids within the prior 30 days. Almost half of those players said they didn’t use the medication as prescribed.'

https://www.tsn.ca/nhl-alumni-association-strikes-deal-with-cannabis-company-for-medical-exams-brain-scans-1.1266240

'Seventy-two percent of individuals [in the US study] who reported substitution said they had completely ceased opioid use, 68 percent said they stopped taking benzodiazepines and 80 percent got off SSRI anti-depression medication.'

About 70 percent [in the Canadian study] said they used marijuana as a substitute for prescription drugs—35 percent for opioids, 11 percent for anti-depressants, eight percent for anti-seizure medications, four percent for sleeping pills and muscle relaxants and four percent for benzodiazepines.'

https://www.marijuanamoment.net/patients-are-substituting-marijuana-for-addictive-pharmaceutical-drugs-two-new-studies-show/

'“We are pleased to announce that, as of today, opioid use disorder is a condition for which physicians can recommend medical marijuana to patients,” Dr. Shereef Elnahal, the state health commissioner, said in a press release. “We are also taking steps to ensure that these patients will be on MAT for their addiction, in addition to marijuana.”

Previously, individuals addicted to opioids could only qualify for medical cannabis if they became dependent while attempting to treat chronic pain caused by a musculoskeletal disorder.'

https://www.marijuanamoment.net/opioid-addiction-is-now-a-medical-marijuana-qualifying-condition-in-new-jersey/

'Withdrawal symptoms are allergic symptoms: sneezing, coughing, running at the eyes and nose, vomiting, diarrhea, hive-like conditions of the skin. Severe withdrawal symptoms are shock symptoms: lowered blood pressure, loss of body fluid and shrinking of the organism as in the death process, weakness, involuntary orgasms, death through collapse of the circulatory system. If an addict dies from junk withdrawal, he dies of allergic shock.'

- Junky, William S Burroughs, 1977, originally published in 1953

'New Jersey Gov. Phil Murphy’s administration has added opioid addiction to the list of qualifying conditions that are treatable with medical marijuana, a move that could provide a boost to MMJ sales.

In 2015, New Jersey health care providers wrote 55 opioid prescriptions per 100 persons, or 4.9 million prescriptions, according to the National Institute on Drug Abuse.'
https://mjbizdaily.com/new-jersey-adds-opioid-addiction-as-medical-cannabis-qualifying-condition/

'Medical marijuana dispensaries in Illinois are preparing for a healthy boost in business with the launch of a pilot program this month that will offer patients access to MMJ as an alternative to opioids.

Dispensaries are extending hours and hiring additional workers for the expected increased demand in medical cannabis once the Opioid Alternative Pilot Program starts at the end of January, the Chicago Tribune reported.'
https://mjbizdaily.com/illinois-medical-cannabis-dispensaries-business-boom/

'While a relatively small number of studies ultimately fell within the parameters of this analysis, research on cannabis and opioids has rapidly expanded in recent years—due in no small part to the explosion of the opioid crisis—and the evidence has widely supported the idea that cannabis can reduce the harms of the drug problem.'
https://www.marijuanamoment.net/new-analysis-explores-relationship-between-medical-marijuana-and-opioid-overdoses/

'It would seem that junk is the only habit-forming drug. Cats cannot be addicted to morphine, as they react to an injection of morphine with acute delirium. Cats have a relatively small quantity of histamine in the blood stream. It would seem that histamine is the defense against morphine, and that cats, lacking this defense, cannot tolerate morphine. Perhaps the mechanism of withdrawal is this: Histamine is produced by the body as a defense against morphine during the period of addiction. When the drug is withdrawn, the body continues to produce histamine.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Looking at mortality records from 2009 to 2015, a team of researchers investigated whether the presence of dispensaries in counties with medical cannabis laws had an effect on deaths from prescription opioids, synthetic opioids and heroin. The results supported previous research, indicating that access to marijuana can mitigate the opioid epidemic.

But not all counties in legal states allow dispensaries to operate. The study found that counties with dispensaries experience six to eight percent fewer opioid overdose deaths overall and 10 percent fewer heroin overdose deaths.'
https://www.marijuanamoment.net/marijuana-dispensaries-reduce-local-opioid-overdose-rates-study-finds/

'1. People with severe arthritis that required reconstructive joint surgery are using more cannabis and fewer opioids.
2. The number of opioid prescriptions, days of opioid supply and patients receiving opioid prescriptions are lower in states that have legalized marijuana for medical or adult use.
3. Opioid misuse dropped from 2016 to 2017, while cannabis usage increased.'
https://www.marijuanamoment.net/three-new-studies-reveal-how-legal-marijuana-can-help-curb-opioids/

'"The signal to us is that we can't continue to flirt with cannabis because cannabis has now conclusively been demonstrated to be a drug-related plant that is medicinal and has properties that are incredible. Even the great United States has concluded, 10 years of research is now showing that it is a healthy and appropriate alternative to opioid.'
http://jamaica-gleaner.com/article/lead-stories/20181022/shaw-high-weed-minister-sees-increased-earning-potential-jamaica

Legalize the ganja worldwide as a harm reduction strategy...

'Results
The open-web crawling/navigating software identified some 426 opioids, including 234 fentanyl analogs. Of these, 176 substances (162 were very potent fentanyls, including two ohmefentanyl and seven carfentanyl analogs) were not listed in either international or European NPS databases.

Conclusion
A web crawling approach helped in identifying a large number, indeed higher than that listed by European/international agencies, of unknown opioids likely to possess a significant misuse potential. Most of these novel/emerging substances are still relatively unknown. This is a reason of concern; each of these analogs potentially presents with different toxicodynamic profiles, and there is a lack of docking, preclinical, and clinical observations. Strengthening multidisciplinary collaboration between clinicians and bioinformatics may prove useful in better assessing public health risks associated with opioids'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093327/

'When you are junk sick you dream about junk. A curious fact about junk dreams is that something always happens to prevent you from getting a shot. The cops rush in, the needle stops up, the dropper breaks. Anyway, you never get it. I have talked to other users, and I have never known anyone who ever got fixed in a dream.'

- Junky, William S Burroughs, 1977, originally published in 1953

'The type of substance used, the route of administration and the health of the user all have an impact on the risk of overdose. Most overdose deaths are linked to the use of opioids, primarily the injection of heroin or synthetic opioids, while polydrug use is also very common, including the combination of heroin or other opioids with other central nervous system depressants, such as alcohol or benzodiazepines, which bears particularly high risks. Using/injecting alone is also a risk factor for overdose death.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#section3

'Scotland’s drug-death rate among adults (15–64 years) is higher than those reported for all the EU countries (although there are issues of coding, coverage and under-reporting in some countries). To illustrate the scale of the problem, Scotland with a population of 5.5 million reports a similar number of overdose deaths as Germany does that has a population of 83 million. Most cases in Scotland are associated with opioids (9 in 10) and benzodiazepines (7 in 10) but almost all 85% involve more than one drug. Recent increases are primarily seen in the 35–44 and 45–54 age groups.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#section4

'llicitly manufactured fentanyl and its analogues are involved in large numbers of deaths in some countries, such as Estonia, and Sweden which saw a peak in 2017. In England, in the spring of 2017, intelligence from post-mortem results and drug seizures suggested that fentanyl and its analogues had been introduced into the heroin supply in the north of the country. Public Health England issued an alert at the end of April 2017 advising (1) on the availability of, and harms from, heroin that had been mixed with fentanyl or carfentanil, (2) that warnings be cascaded and (3) of the naloxone dosing regime in the event of an overdose (see the figure above). Read more in the report.

It is very important to follow closely any signal and alert about harms related to fentanyl and fentanyl analogues, because these substances have a very high toxicity, compared to other opioids, namely heroin. They have therefore the potential to create large clusters of incidents and of deaths if they enter the drug markets in Europe.'
http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#section4

'Any kind of opioid drug “has the potential to kill people,” Vigil said Monday. “Cannabis doesn’t.” Opioid overdoses kill about 90 people a day in the U.S. on average, the study notes. “This notion of allowing patients to manage their own medical treatment is rather innovative, and it takes a lot of third parties out of the system,” he said. “I think that patients appreciate that.”'

'Opium is formed in the unripe seed pods of the poppy plant. Its function is to protect the seeds from drying out until the plant is ready to die and the seeds are mature. Junk continues to function in the human organism as it did in the seed pod of the poppy. It protects and cushions the body like a warm blanket while death grows to maturity inside. When a junkie is really loaded with junk he looks dead. Junk turns the user into a plant. Plants do not feel pain since pain has no function in a stationary organism. Junk is a pain killer. A plant has no libido in the human or animal sense. Junk replaces the sex drive. Seeding is the sex of the plant and the function of opium is to delay seeding.
Perhaps the intense discomfort of withdrawal is the transition from plant back to animal, from a painless, sexless, timeless state back to sex and pain and time, from death back to life.'

- Junky, William S Burroughs, 1977, originally published in 1953

Affordable universal health care...

'Two papers published Monday in JAMA Internal Medicine analyzing more than five years of Medicare Part D and Medicaid prescription data found that after states legalized weed, the number of opioid prescriptions and the daily dose of opioids went way down.'

'A prescription for an opioid drug such as Percocet or Vicodin can offer pain relief, but it also comes with the potential for abuse and addiction. In the past 20 years the number of overdose deaths from these drugs has more than tripled. In examining whether a legitimate prescription for opioid drugs increases the likelihood of later misuse for teens, a recent study uncovered a surprising trend: it's the drug-naive teens who are most at risk.'

'Physicians wrote significantly fewer prescriptions for painkillers and other medications for elderly and disabled patients who had legal access to medical marijuana, a new study finds.'

'The US is seeing record numbers of deaths from prescription painkillers and illegal opioids such as heroin. Some people become addicted to opioids when they start using prescription painkillers such as oxycodone for a health problem, and later end up switching to illegally obtained prescription medications or heroin.

Officially sponsored myth 1 -'"All drugs are more or less similar and all are habit forming." This myth lumps cocaine, marijuana and junk together. Marijuana is not at all habit forming and its action is almost the direct opposite from junk action. There is no habit to cocaine. You can develop a tremendous craving for cocaine, but you won't be sick if you can't get it. When you have a junk habit, on the other hand, you live in a state of chronic poisoning for which junk itself is the specific antidote. If you don't get the antidote at eight-hour intervals, and enough of it, you develop symptoms of allergic poisoning: yawning, sneezing, watering of the eyes and nose, cramps, vomiting and diarrhea, hot and cold flushes, loss of appetite, insomnia, restlessness and weakness, in some cases circulatory collapse and death from allergic shock....When I say "habit-forming drug" I mean a drug that alters the endocrinal balance of the body in such a way that the body requires that drug in order to function. So far as I know, junk is the only habit forming drug according to this definition.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population

Interview with W. David Bradford, PhD, author of Association Between US State Medical Cannabis Laws and Opioid Prescribing in the Medicare Part D Population, Jason M Hockenberry, PhD, author of Association of Medical and Adult-Use Marijuana Laws With Opioid Prescribing for Medicaid Enrollees, and Kevin P. Hill, MD, MHS, author of The Role of Cannabis Legalization in the Opioid Crisis'
https://jamanetwork.com/learning/audio-player/16296336

'Between 2009 and 2010, 50% of patients admitted to hospitals for medical conditions received narcotics, and huge volumes of oxycodone and other opioids were produced, distributed, used, diverted, and abused. Opioid addiction and deaths, especially from heroin, continued to skyrocket.'
https://www.amjmed.com/article/S0002-9343(18)30084-6/fulltext

'It has been demonstrated that pain management patients supplement their opioid therapy with marijuana use and even substitute marijuana for prescription opioids which may reflect marijuana’s analgesic and sedative properties.'
http://journals.sagepub.com/doi/full/10.1177/1178221817724783

'Overall, these PROs underscore four key points: 1) individuals are substituting cannabis for prescription drugs, independent of whether they identify themselves as medical users (medical users are doing so at almost five times the odds of non-medical users) and independent of legal access to medical cannabis; 2) this practice increases in frequency with age, up to 65 years, and is more common in females, particularly female medical users, and Native American/Asians/Pacific Islanders; 3) the most common classes of substitution were narcotics/opioids, anxiolytics/benzodiazepines and antidepressants; and 4) the odds of reporting substituting cannabis for prescription drugs were more than one and a half times greater among those reporting the use of cannabis to manage pain, anxiety and depression than among those using it to manage only one of these three conditions. Stated differently, pain, anxiety and depression seem to represent a comorbidity triad that is associated with greater substitution frequency.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422566/

Officially sponsored myth 2 - '"A drug habit is formed instantly, on first use, or at most, after three or four shots." From this notion derive the stories of people becoming addicts after using a few "headache pills" given them by the Sympathetic Stranger. Actually, a non-user would have to take a shot every day for at least a month to get any kind of habit. The Stranger would go broke handing out samples. But a cured addict, even if he has not used it for years, can get a new habit in a few days. He is allergic to junk.'

- Junky, William S Burroughs, 1977, originally published in 1953

'An analysis of nearly three years of prescribing data up to February 2014 found that northern England contained 9 out of 10 of the regions where eight opioid painkillers were most frequently prescribed.'
https://www.newscientist.com/article/2161121-opioid-painkillers-are-prescribed-more-in-northern-england/

'By 2013, over 1,000 Americans were treated daily in emergency departments for prescription opioid misuse and in 2014, 4.3 million people used prescription opioids for non-medical reasons. This trend was also seen in the number of deaths attributed to oxycodone, which increased from 14 cases in 1998 to ~14,000 cases in 2006 and 18,000 in 2015. Although not of the same magnitude and somewhat delayed, this increase in opioid abuse and mortality is also occurring in other countries. In Australia, oxycodone-related deaths increased sevenfold between 2001 and 2011. In Finland, opioid mortalities increased from 9.5% of all drug overdose deaths in 2000 to 32.4% in 2008, and data from Brazil, China, and the Middle East show similar increases in opioid diversion. In the United Kingdom, although tramadol and methadone are misused over oxycodone, the pattern of opioid misuse shows a similar increase to the USA albeit on a smaller scale. While Americans consume 80% of the global opioid supply and 99% of the global hydrocodone supply and the number of overdose mortalities is considerably higher in the USA, the opioid epidemic is growing worldwide.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925443/

'A cannabis initiative team at UCLA plans to conduct a high-quality clinical study of the painkilling properties of pot — and perhaps stem the opioid epidemic.'
https://www.nbcnews.com/storyline/legal-pot/amid-opioid-crisis-researchers-aim-put-medical-marijuana-test-n904276

'“The side effect profile, in particular the risk for dependence, addiction, overdose, death — all of those are much lower and nonexistent for marijuana versus opioids. The other thing is we’re not necessarily recommending it as a first-line therapy, we’re just allowing you now to recommend it as a first-line therapy. It’s still a clinical judgement,” Elnahal replied.'
https://www.njtvonline.org/news/video/health-commissioner-marijuana-program-needs-more-doctors-to-participate/

'Among people who use illicit drugs initiating opioid agonist treatment in Vancouver, at least daily cannabis use was associated with approximately 21% greater odds of retention in treatment compared with less than daily consumption.'
https://onlinelibrary.wiley.com/doi/10.1111/add.14398

Officially sponsored myth 3 - '"Once a habit is formed escape is almost impossible." Actually, a habit is easily cured. The usual cure takes from ten days to three weeks. You don't need any "will power." If the cure is done right there is very little discomfort.'

- Junky, William S Burroughs, 1977, originally published in 1953

'Opioids, mainly heroin or its metabolites, often in combination with other substances, are present in the majority of fatal overdoses reported in Europe. In most drug-related deaths, more than one substance is detected, indicating polydrug use.

Overall, opioids are involved in 77.8 % of cases, with large differences across countries (see more country-level data in the Statistical Bulletin).'

http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en#question11

'An update from the EMCDDA expert network, published in July 2019, also highlighted that opioids, often heroin, are involved in between 8 and 9 out of every 10 drug-induced deaths reported in Europe, although this is not true for all countries. Opioids used in substitution treatment can also be found in post-mortem analyses in some countries. Deaths related to medications, such as oxycodone and tramadol, are also reported. Deaths associated with fentanyl and its analogues are probably underestimated, and outbreaks of deaths related to these substances have been reported'

http://www.emcdda.europa.eu/publications/topic-overviews/content/faq-drug-overdose-deaths-in-europe_en

Legalize marijuana so it can be grown at home nationwide and so that it becomes accessible to all. People will then have a choice of using marijuana or FDA approved opioids. Let them choose the course of medication that they want to pursue instead of giving them no option other than opioids. Right to choose one's medication is a right to freedom of an individual. Given a choice and awareness, the majority of people will definitely want to choose health.

Legalize marijuana.

'Fentanyl, the synthetic opioid about 50 times stronger than heroin, has ravaged communities across the nation. In places like Philadelphia, the problem is only getting worse. Reporter Wesley Lowery investigates.'
https://www.youtube.com/watch?v=88lo6U4OiQ8

Well, the plant that intoxicated then is now the backbone of the pharmaceutical industry with a large part of the world addicted to it, not in its natural form which would probably have been healthier, but in its refined and deadlier forms as prescription painkillers, oxycontin, codeine, morphine, opioids, heroin and fantanyl. In addition to the genteel British habit of tea drinking, if Britain and the rest of the world also developed the habit of enjoying the other tea, cannabis, that would have been much better.

'Brian Cox learns the origins and history of the modern-day opium addiction. Taken from Addicted To Pleasure.'
https://www.youtube.com/watch?v=2AFUPv7DRxs

The Chinese official blames the legalization of marijuana for the rise in use of fentanyl in the US. Bizarre.

'One of the key sources of fentanyl in the United States is China. VICE News follows the path of the dangerous drug as it moves overseas onto U.S. soil and the effort to keep it from reaching the streets.'
https://www.youtube.com/watch?v=kbPlnRJQGrc

Legalize recreational marijuana in Texas, federal USA, China and worldwide to wean the world off fentanyl and other opioids being used as painkillers.

'A doting father turned to the Dark Web to feed his addiction. Within months he was a fentanyl kingpin in Texas’s Panhandle.'
https://www.youtube.com/watch?v=1b-MeK5-NaQ

Now, now..is this the connection between opium and pandemics, the double-edged sword, that officials and the opium industry try to leverage for their personal benefit time and again?

Officially sponsored myth 4 - '"Addiction ruins the health and leads to early death." As I read in a magazine article; "Morphine addicts have numbered days on earth." Who hasn't?
The addict enjoys normal health and lives as long, or longer, than the average. Junk conveys a considerable immunity to respiratory complaints. During the "flu" epidemic of 1918 junkies were found to be immune to flu a nd some addicts were let out of jail to help care for the sick. On the other hand, all users suffer somewhat from constipation and loss of appetite. Most of them lose weight, often running from ten to twenty pounds below normal during addiction.'

- Junky, William S Burroughs, 1977, originally published in 1953

Legalize marijuana in Philadelphia, Pennysylvania, New York, New Jersey, Maryland, federal USA, China and worldwide to provide people with a natural recreational alternative to deadly fentanyl.

'Overdoses linked to fentanyl, a synthetic opioid up to 50 times stronger than heroin, killed nearly 30,000 people in the United States in 2017. Authorities say most fentanyl sold in the state of Pennsylvania can be traced back to China. We went to Kensington, an area considered a “ground zero” of America’s opioid crisis, in the Pennsylvanian city of Philadelphia, to find out how a drug funneled through from China is fueling a health crisis half a world away.'
https://www.youtube.com/watch?v=tC4LJ5YilwE

'Up to 50 times more powerful than heroin, the synthetic painkiller Fentanyl presents a new level of peril in America's opioid crisis. Joseph Murphy's addiction tore his family apart; now they're aiming to piece their life back together. WSJ Video: Robert Libetti. Photo: Kieran Kesner for The Wall Street Journal'
https://www.youtube.com/watch?v=2rvFfbI3nmI

'Indian tramadol networks have even been linked to ISIS and Boko Haram, raising security concerns. There have been several instances of seizures of tramadol from India destined for Islamic State territory. In May, $75 million worth of tramadol, about 37 million pills, was seized in Italy en route to Misrata and Tobruk, Libya; ISIS had purchased them for resale to ever-growing markets. The group has been involved in both the trafficking and consumption of tramadol, and the quantity of drugs being purchased by ISIS is so great that it can be assumed the group is selling a significant portion for profit.

The 37 million tramadol tablets purchased by ISIS had taken a familiar route from India through Southeast Asia. Neither India nor many Southeast Asian countries regulate tramadol, and since tramadol is not on the international drug schedule, it is only regulated if individual countries decide to classify it. But, if only one country classifies the drug and places it under regulation, it will not necessarily affect the supply. This was a problem for Egypt, which scheduled tramadol in hope of curbing abuse. Despite this, Indian tramadol exports to Egypt continued to rise and tramadol is the most abused drug in Egypt today.'
https://www.csis.org/npfp/dangerous-opioid-india

Officially sponsored myth 5 - '"Addicts never get enough. They have to keep raising the dosage. They need more and more. Finally, I quote from a recent movie called Johnny Stool Pigeon - They tear the clothes off their skinny bodies and die screaming - for more junk."
This is preposterous. Addicts get enough and they do not have to raise the dosage. I know addicts who have used the same dose for years. Of course, addicts do occasionally die if they are cut off the junk cold. They don't die because they need more and more. They die because they can't get any.'

- Junky, William S Burroughs, 1977, originally published in 1953

The report says that India is exporting Tramadol to Cameroon where it reaches school children. Legalize ganja in Cameroon and India so that people do not get hooked onto pharmaceutical painkillers.
https://www.youtube.com/watch?v=dlkkfpxmXJk

'Fentanyl, a drug more potent that heroin, is the latest iteration of America's evolving opioid epidemic.'
https://www.youtube.com/watch?v=BXmyPsqkP44

'Hamilton Morris explains why fentanyl was created.'
https://www.youtube.com/watch?v=ihCe6_H7JWk

'Highlights - delta9-tetrahydrocannabinol (THC) enhances the antinociceptive effects of oxycodone; Vaporized and injected THC reduces oxycodone self-administration; Cannabinoids may reduce opioid use for analgesia; Cannabinoids may reduce nonmedical opioid use.'
https://www.sciencedirect.com/science/article/pii/S0028390819301212

https://norml.org/marijuana/fact-sheets/item/relationship-between-marijuana-and-opioids

'In 2010, opioid use and dependence made the largest contribution to morbidity and mortality from illicit drug use, contributing to premature death from drug overdose and suicide, and in those who inject these drugs, infection with HIV and other blood-borne viruses. Dependence also produced considerable disability. Afghanistan has a tradition of opium smoking, and has long been a major source of illegal opiates for eastern and western Europe. In the past decade, Afghans have also reportedly begun to inject heroin and use pharmaceutical opioids. These developments have been attributed to increased heroin availability, civil disruption from insurgency, and the crowding of displaced Afghans into urban areas where heroin and pharmaceutical opioids are readily available.'
https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70299-2/fulltext

The article goes on to say that many people avoid marijuana for pain relief because of the stoner stereotype stigma ..so it appears that to be a prescription opium addict that everybody accepts (even if it kills you) is preferable to being seen as a stoner..and here i am thinking how cool being a stoner is...

'If people who are addicted lose access to prescription opioids, they may turn to dangerous illegal opioids, such as heroin, Live Science previously reported. But experts say medical marijuana and synthetic cannabinoids have been found to be highly effective for certain types of pain relief and carry a much lower risk of addiction than opioids.'
https://www.livescience.com/61700-can-marijuana-curb-opioid-epidemic.html

Officially sponsored myth 9 - '"There is a connection between junk and insanity. Addicts turn into maniacs when they cannot get junk."
Actually, I have never seen or heard of an insane addict. For some reason, the two conditions do not occur together.'

- Junky, William S Burroughs, 1977, originally published in 1953

'This study investigates prior prescription opioid misuse in a cohort of heroin users whose progress was tracked in a treatment study conducted in the US from 2006 to 2010. Half of the sample misused prescription opioids (“other opiates/analgesics”) prior to their onset of heroin misuse (POBs). We found that POBs were demographically younger and more likely to be white than other heroin users (OHUs). There were differences between the two groups with respect to the reporting of at least one year of regular use of substances and age of onset of substance use. POBs were more likely to report regular use, and earlier onset of use of several substances, mostly of the type potentially obtained via prescription. POBs were more persistent in their opioid use and more likely to suffer near-term elevated depressive symptoms compared with OHUs. These findings suggest that heroin addiction treatment may need to be tailored according to opioid misuse history.'
https://www.sciencedirect.com/science/article/pii/S2352853218300117

Still, the number of drug overdose deaths continued to climb to a staggering 72,000 in 2017, with the sharpest increase among people who used fentanyl or other synthetic opioids. “All it takes is one exposure to fentanyl to die,” Kan said.'
https://www.scientificamerican.com/article/number-of-new-heroin-users-drops-but-overdose-deaths-continue-to-climb/

'Kerala State Mental Health Authority secretary D. Raju said addiction to intravenously administered painkillers was on the rise and more prevalent among adolescents, given the “risk-taking behaviour characteristic of their age”. He said Buprenorphine, a potent analgesic that could legally be stocked only in licensed hospitals, was the most abused drug. It was used to alleviate withdrawal symptoms of heroin addicts'
https://www.thehindu.com/news/cities/Thiruvananthapuram/pain-medication-addiction-on-the-rise/article2626481.ece

'Of the 6.7 million users, 4.25 million were drug dependent. Charas, a resin obtained from marijuana was used by four million people and heroin by 860,000. In addition injecting drug users numbered 430,000.

A challenge for Pakistan is the very limited treatment centres, especially for women, he said. With a high number of drug dependents, treatment and specialist intervention was available to less than 30,000 users a year.

While poppy is grown in Afghanistan drugs are trafficked through Pakistan.

A lot of the heroin and opiates are found here because it is at a crossroads of a big complicated business network as it goes to Europe, Asia and North America.'
https://www.thehindu.com/todays-paper/tp-international/in-pakistan-drug-usage-linked-to-high-prevalence-of-hiv/article5768405.ece

'Federal and state narcotic authorities put every obstacle in the way of addicts who want a cure. No reduction cures are given in city or state institutions. Two hundred dollars is minimum for a ten-day cure in a private sanatorium. Hospitals are forbidden by law to give addicts any junk. I knew an addict who needed an operation for stomach cancer. The hospital could not give him any junk. Sudden withdrawal of junk plus the operation would likely have killed him so he decided to skip the operation.'

- Junky, William S Burroughs, 1977, originally published in 1953

The doctor attributed the drop in new heroin users to increased government funding for prevention and public messaging on the local, state and federal levels. The possibility of marijuana playing a role in harm reduction was not discussed though the opportunity to highlight its potential risks was not missed.
'Some good news from the front lines of the heroin crisis: Half as many people tried heroin for the first time in 2017 as in 2016. That’s according to data released Friday from the government’s annual National Survey on Drug Use and Health.

“This is what we were hoping for,” said Dr. Elinore McCance-Katz, who directs the Substance Abuse and Mental Health Services Administration. “It tells us that we are getting the word out to the American people of the risks of heroin,” especially when the drug is tainted with additional powerful opioids, fentanyl or carfentanil.'
https://www.scientificamerican.com/article/number-of-new-heroin-users-drops-but-overdose-deaths-continue-to-climb/

'“Fentanyl deaths are up, a 45 percent increase; that is not a success,” said Dr. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco. “We have a heroin and synthetic opioid epidemic that is out of control and needs to be addressed.”

Synthetic drugs tend to be more deadly than prescription pills and heroin for two main reasons. They are usually more potent, meaning small errors in measurement can lead to an overdose. The blends of synthetic drugs also tend to change frequently, making it easy for drug users to underestimate the strength of the drug they are injecting. In some parts of the country, drugs sold as heroin are exclusively fentanyls now.'
https://www.nytimes.com/interactive/2018/11/29/upshot/fentanyl-drug-overdose-deaths.html

Are international pharma companies shifting their underutilized supplies of opioids to countries like India that remain apparently oblivious to the changes in the US medical and health market?

I suspect that many societies around the world have not even become conscious of Fentanyl. People are too busy everywhere fighting hemp and its "cousin" ganja while the real killers silently go about taking lives. The US has seen so much damage from opioids including Fentanyl and is the most informed, yet it still continues to waste money and resources on keeping ganja federally banned, creating hurdles to ganja legalization and thus indirectly supporting the opioid market.

'Then fentanyl hit the streets. A synthetic opioid developed in 1960 by a Belgian physician, fentanyl is normally reserved for surgery and cancer patients. It is up to 100 times more powerful than morphine, its chemical cousin.

For traffickers, illicit fentanyl produced in labs was the most lucrative opportunity yet, a chance to bypass the unpredictability of the poppy fields that produced their heroin. The traffickers could order one of the cheapest and most powerful opioids on the planet directly from Chinese labs over the Internet.

It was 20 times more profitable than heroin by weight. By lacing a little of the white powdery drug into their heroin, the dealers could make their product more potent and more compelling to users. They called it China White, China Girl, Apache, Dance Fever, Goodfella, Murder 8 or Tango & Cash.'
https://www.washingtonpost.com/graphics/2019/national/fentanyl-epidemic-obama-administration/

'The new law is a response to the epidemic of overdose deaths from narcotics, which killed almost 2,000 people in the state in 2016 and an estimated 72,000 people nationwide last year. It would allow doctors to authorize medical marijuana for any patient who has or would qualify for a prescription for opioids like OxyContin, Percocet or Vicodin.'
http://www.chicagotribune.com/news/local/breaking/ct-met-medical-marijuana-opioids-illinois-expansion-20180827-story.html

Medical and adult-use marijuana laws have the potential to lower opioid prescribing for Medicaid enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose, and marijuana liberalization may serve as a component of a comprehensive package to tackle the opioid epidemic.
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2677000

'“Long stressful work hours, easy access to painkillers and drugs such as Morphine, a habit of self-diagnosis and self-medication — that is, unwillingness for a doctor to be the patient — are contributing factors for doctors taking up tobacco or other drugs,” he said, adding that a recent study showed that 43 per cent of doctors who admitted using opioids had kept it hidden from society for over two years.'
https://www.thehindu.com/news/cities/Mangalore/police-grapple-with-staff-shortage-as-drug-abuse-concerns-rise/article6154398.ece

Many people are ignorant of the fact that opium and marijuana are two different plants. While both plants are illegal to cultivate worldwide, opium is the source of a large number of pharmaceutical drugs that use morphine, codeine, oxycodone as well as the source of recreational heroin. Opium is a confirmed lethal drug causing serious addiction and death, yet it has been widely embraced by many especially the pharma industry and drug traffickers whereas the relatively harmless and more medicinal marijuana has been shunned and criminalized. Many people do not hesitate to club marijuana and opium under the same term 'drug' negatively without understanding the vast differences between the two. A lot of the negative propaganda against marijuana is essentially fueled by the damage caused by opium and its derivatives and the misinformation surrounding the two plants.

'Conclusions
Opioids Epidemic - Some evidence for progress: Number of new users of heroin decreased from 170,000 in 2016 to 81,000 in 2017; Significant increases in those with SUDs receiving treatment in specialty settings and physician office settings
NSDUH reveals areas where we need to focus resources:
    Transitional aged youth:
    mental illness and substance use disorders; Addressing co-occurring mental and substance use disorders (8.3% in need received treatment); Women, and particularly, pregnant women with increasing use of substance'
https://www.samhsa.gov/data/sites/default/files/nsduh-ppt-09-2018.pdf

'Cannabis alone will not end opioid use disorder and associated morbidities and mortality. However, the introduction of ever more powerful opioids like fentanyl and carfentanyl into the illicit drug market and the resulting day-to-day increase in opioid overdoses highlights the immediate need for innovative short and long term intervention strategies to add to current efforts like ORT, heroin maintenance programs, supervised consumption sites, the depenalization of substance use, and increased education and outreach on the potential harms associated with both prescription and illicit opioid use. The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to seek the immediate implementation of cannabis-based interventions in the opioid crisis at the regional and national level, and to subsequently assess their potential impacts on public health and safety'
https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-017-0183-9

'We found that heroin use is not simply an inner-city problem among minority populations but now extends to white, middle-class people living outside of large urban areas, and these recent users exhibit the same drug use patterns as those abusing prescription opioids. In this connection, our data indicate that many heroin users transitioned from prescription opioids. The factors driving this shift may be related to the fact that heroin is cheaper and more accessible than prescription opioids, and there seems to be widespread acceptance of heroin use among those who abuse opioid products.'
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575

'Fentanyl exported from China to the United States comes in several different forms: fentanyl, its precursor chemicals, fentanyl variants, and fentanyl-laced counterfeit prescription opioids. India exports many controlled and prescription drugs to the United States, including fentanyl. Indian fentanyl exports to the United States are a fraction of those from China, but India does export tramadol, which is a growing issue for the United States. However, unlike China, which has now designated over 100 fentanyl variants and precursors on its list of controlled substances, India has not placed fentanyl, or most other opioids, on its controlled substances list, easing production and export. India only regulates 17 of the 24 basic precursor chemicals for fentanyl (as listed by the UN 1988 Convention against Drugs).

In the Middle East and Africa, the less potent opioid tramadol, not fentanyl, is responsible for the opioid crisis. India is the biggest supplier.'
https://www.csis.org/npfp/dangerous-opioid-india

'Tramadol is not on the international drug schedule, or a controlled substances list that mandates regulation, under the World Health Organization (WHO) and so individual countries’ attempts to regulate it often fail. For example, Egypt first scheduled tramadol in 2002 because of growing tramadol use, but since tramadol was not on the international drug schedule, India was not obligated to notify Egypt of an upcoming tramadol export. Thus, Indian exports to Egypt continued to rise and tramadol is the most abused drug in Egypt today. Egypt’s National Council on Fighting and Treating Addiction reported in 2013 that 30 percent of adults abused drugs.'
https://www.csis.org/npfp/dangerous-opioid-india

'One potential reason India does not regulate tramadol, or other opioids, is the lack of domestic concern about addiction. However, India does have addiction problems, and India’s Home Minister Shri Rajnath Singh specifically acknowledged that tramadol addiction is a growing problem.Yet, the government acknowledgement has not been sufficient; government corruption plays a role with the pharmaceutical corporations, wholesale exporters, and internet companies responsible for the illicit flow of opioids out of India. In their 2017 report on corruption, Transparency International found that India had the highest bribery rates across the Asia Pacific region.'
https://www.csis.org/npfp/dangerous-opioid-india

'In fact, opioids are not particularly effective for treating chronic pain; with long-term use, people can develop tolerance to the drugs and even become more sensitive to pain. And the claim that OxyContin was less addictive than other opioid painkillers was untrue — Purdue Pharma knew that it was addictive, as it admitted in a 2007 lawsuit that resulted in a US$635 million fine for the company. But doctors and patients were unaware of that at the time.
https://www.nature.com/articles/d41586-019-02686-2

'Cultural differences between Europe and North America probably also contribute to the regions’ differing fortunes with opioids. Large-scale surveys show that there is a similar prevalence of pain in France and Italy as there is in the United States. But according to data from the United Nations, US doctors write five and a half times more prescriptions for opioids than do their counterparts in France, and eight times more than do physicians in Italy. Humphreys says that this might be because people in the United States expect to receive a prescription when they go to the doctor with a health concern. Meanwhile, direct advertising of pharmaceuticals to consumers (permitted only in the United States and New Zealand) encourages them to ask doctors for specific drugs.'
https://www.nature.com/articles/d41586-019-02686-2

'The opioid epidemic has had three phases: the first was dominated by prescription opioids, the second by heroin, and the third by cheaper — but more potent — synthetic opioids such as fentanyl. All of these forms of opioid remain relevant to the current crisis. “Basically, we have three epidemics on top of each other,” Humphreys says. “There are plenty of people using all three drugs. And there are plenty of people who start on one and die on another.”'
https://www.nature.com/articles/d41586-019-02686-2

'Codeine is the most commonly used opioid in the world. Regulation of its availability varies among countries; in New Zealand, the United Kingdom, most of Canada, and Ireland, codeine is available as an over-the-counter (OTC) preparation and is often combined with paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen. Despite its wide use, there are a number of concerns about codeine as an analgesic, with risks of prolonged misuse of OTC codeine-ibuprofen products including life-threatening complications such as gastric bleeds, renal failure, hypokalemia, and opioid dependence.

In addition to risk of serious harm, there is limited evidence for the addition of low-dose codeine (16 to 25 mg of codeine per dose) to paracetamol or ibuprofen preparations for improved pain relief. This, coupled with the known availability of effective nonopioid alternatives for pain relief, raises concerns about the place of low-dose codeine in ongoing pain management.'
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101496/

'Codeine is an opiate used to treat pain, coughing, and diarrhea. Serious side effects may include breathing difficulties and addiction. A potentially serious adverse drug reaction, as with other opioids, is respiratory depression. This depression is dose-related and is a mechanism for the potentially fatal consequences of overdose. Codeine works following being broken down by the liver into morphine; how quickly this occurs depends on a person's genetics. It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.'
https://en.wikipedia.org/wiki/Codeine

'About 70 percent of morphine is used to make other opioids such as hydromorphone, oxymorphone, and heroin. Potentially serious side effects include decreased respiratory effort and low blood pressure. Morphine is addictive and prone to abuse.A large overdose can cause asphyxia and death by respiratory depression if the person does not receive medical attention immediately. One poor quality study on morphine overdoses among soldiers reported that the fatal dose was 0.78 mcg/ml in males (~71 mg for an average 90 kg adult man) and 0.98mcg/ml in females (~74 mg for an average 75 kg female). It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system. According to a 2005 estimate by the International Narcotics Control Board, six countries (Australia, Canada, France, Germany, the United Kingdom, and the United States) consume 79% of the world's morphine. The less affluent countries, accounting for 80% of the world's population, consumed only about 6% of the global morphine supply'
https://en.wikipedia.org/wiki/Morphine

'Clinical pathologist Dr. R R Lycette of Queen Elizabeth Hospital in Hong Kong testified Lee's death could not have been caused by cannabis poisoning, but was more likely due to hypersensitivity to one of the elements of Equagesic. Dr. Lycette, who performed the autopsy on Lee, explained hypersensitivity is an adverse reaction of a body to a foreign substance. "The substance which Lee could have been hypersensitive to might have been contained in Equagesic - a tablet he took - but I can't definitely say which compound in the tablet Lee was hypersensitive to," said the doctor.' - The Legend of Bruce Lee by Alex Ben Block, 1974

'The major features of cellular organization, including, for instance, mitosis, must be much older than 500 million years old - more nearly 1000 million,' wrote Geroge Gaylord Simpson and his colleagues Pittendrigh and Tiffany in their broadly encompassing book entitled Life. 'In this sense the world of life, which is surely fragile and complex, is incredibly durable through time - more durable than mountains. This durability is wholly dependent on the almost incredible accuracy with which the inherited information is copied from generation to generation.'

But in all the thousand million years envisioned by these authors no threat has struck so directly and so forcefully at that 'incredible accuracy' as the mid-20th century threat of man-made radiation and man-made and man-disseminated chemicals. Sir Macfarlane Burnet, a distinguished Australian physician and a Nobel Prize winner, considers it 'one of the most significant medical features' of our time that, 'as a by-product of more and more powerful therapeutic procedures and the production of chemical substances outside of biological experiences, the normal protective barriers that kept mutagenic agents from the internal organs have been more and more frequently penetrated.' - Silent Spring, Rachel Carson, 1962

'Lexington and Forth Worth are the only two public institutions in the U.S. that give reduction cures. Both are usually full. According to bureaucratic regulations, anyone seeking admission to either hospital must send an application (in triplicate, of course) to Washington and wait several months to be admitted. Then he must stay at least six months. In Louisiana a man could be arrested as a drug addict if he applied for the cure.'

- Junky, William S Burroughs, 1977, originally published in 1953

Cannabis meets all these criteria plus it it naturally growing worldwide and has been used for tens of thousands of years...no need for a new drug, we just need to bring it back..reefer madness had clouded even Huxley's mind at the time that this was written...

'What is needed is a new drug which will relieve and console our suffering species without doing more harm in the long run than it does good in the short. Such a drug must be potent in minute doses and synthesizable. If it does not possess these qualities, its production, like that of wine, beer, spirits and tobacco will interfere with the raising of indispensible food and fibres. It must be less toxic than opium or cocaine, less likely to produce undesirable social consequences than alcohol or the barbiturates, less inimical to the heart and lungs than the tars and nicotine of cigarettes. And, on the positive side, it should produce changes in consciousness more interesting, more intrinsically valuable than mere sedation or dreaminess, delusions of impotence or release from inhibition.' - The Doors of Perception, Aldous Huxley, 1954.

'In Hong Kong however, where there is almost no marijuana use, the drug conjures up images of harder drugs, much as "grass" used to be considered the "devil weed" in the United States before its usage spread in the late 1960s. Police in Hong Kong, even now, tend to pay more attention to hash or grass, it seems, than heroin or opium, simply because the substances are less familiar and have come to be associated with the dreaded "hippie tourist Europeans" (anyone in Hong Kong who is not Chinese, and who has white skin, is called a European, just as all Japanese and Chinese are lumped together in America with Vietnamese and others as Orientals).' - The Legend of Bruce Lee by Alex Ben Block, 1974

Thoughts from the void

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Wednesday 17 April 2019

Cannabis and Opium

The opium crisis

Opium - the drug of the elites

How opium conquered the world

Key opium cultivation areas

Opium processing and distribution

The roles played by the pharmaceutical and medical industry

Opium for managing the pain of the elites

The hydra-like qualities of opium

Putting on a charade of containing opium

The opium experience

Other associated harms of opium usage besides addiction and overdose deaths

The causes behind the opium crisis

How can we tackle the opium crisis?

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